Devices and methods for facilitating ejection of surgical fasteners from cartridges

ABSTRACT

Devices and methods are provided for stabilizing fasteners post-deployment. Devices and methods are also provided for facilitating ejection of surgical fasteners from a cartridge. Devices and methods are also provided for guiding surgical fasteners. Devices and methods are also provided for facilitating closing and clamping of an end effector of a surgical device. Devices and methods are also provided for securing fasteners and adjunct materials to tissue. Devices and methods are also provided for removably coupling a cartridge to an end effector of a surgical device. Devices and methods are also provided for locking a surgical device based on loading of a fastener cartridge in the surgical device. Devices and methods are provided for adjusting a tissue gap of an end effector of a surgical device. Devices and methods are also provided for manually retracting a drive shaft, drive beam, and associated components.

FIELD OF THE INVENTION

The present application is a continuation of U.S. patent applicationSer. No. 15/700,278 filed Sep. 11, 2017 and entitled “Devices AndMethods For Facilitating Ejection Of Surgical Fasteners FromCartridges,” which is a continuation of U.S. patent application Ser. No.14/475,144, now U.S. Pat. No. 9,788,835, filed Sep. 2, 2014 and entitled“Devices And Methods For Facilitating Ejection Of Surgical FastenersFrom Cartridges,” which are hereby incorporated by reference in theirentireties herein.

BACKGROUND

Minimally invasive surgical instruments are often preferred overtraditional open surgical devices due to the reduced post-operativerecovery time and minimal scarring associated with minimally invasiveprocedures. Laparoscopic surgery is one type of minimally invasivesurgery (MIS) procedure in which one or more small incisions are formedin the abdomen and a trocar is inserted through the incision to form apathway that provides access to the abdominal cavity. The trocar is usedto introduce various instruments and tools into the abdominal cavity, aswell as to provide insufflation to elevate the abdominal wall above theorgans. Endoscopic surgery is another type of MIS procedure in whichelongate flexible shafts are introduced into the body through a naturalorifice.

Due to the benefits associated with minimally invasive surgeries,significant efforts have gone into developing a range of endoscopic andlaparoscopic surgical instruments that are suitable for preciseplacement of a distal end effector at a desired surgical site. Thesedistal end effectors engage the tissue in a number of ways to achieve adiagnostic or therapeutic effect (e.g., grasper, cutter, stapler, clipapplier, access device, drug/gene therapy delivery device, and energydevice using ultrasound, radiofrequency, laser, etc.).

For example, staplers including end effectors for grasping tissue havebeen developed which secure tissue between two jaws. Staples containedin one of the jaws can be driven into the grasped tissue and deformed tohold the tissue by impinging on the other jaw. The staples can form apredetermined pattern (e.g., one or more lines of staples) based uponthe configuration of the staples in the one of the jaws. The stapler canbe a linear stapler, in which the predetermined pattern includes one ormore longitudinal lines of staples. Though staplers can be effective tograsp and staple tissue, it can be difficult to grasp and/or staple thetissue based on a variety of factors, such as a size and/or shape of thestaple, a thickness and/or toughness of the tissue, etc.

Some staplers can be refilled after firing staples. In some staplers,the staples can be contained in a cartridge which can be removable fromthe stapler's jaw to allow the stapler to be refilled with staplescontained in another cartridge inserted into the jaw. However, thisrefilling of cartridges can be difficult since the cartridges can berelatively small and accordingly difficult to manipulate and/or properlysecure within the jaw. Refilling a stapler with a new cartridge can thusbe time consuming and/or can result in an improperly loaded cartridgethat can misfire staples or otherwise function improperly during use ona patient.

Accordingly, there remains a need for improved methods and devices forstapling tissue.

SUMMARY

A surgical fastening device comprises an elongate shaft having an endeffector coupled to a distal end thereof, wherein the end effectorincludes first and second opposed jaws coupled to one another andconfigured to engage tissue therebetween. The device also includes astaple cartridge disposed within the first jaw. The staple cartridgeincludes a plurality of D-shaped, plastically deformable staples, eachstaple being configured to rotate in a first direction into tissueengaged between the first and second jaws. Each staple has ananti-rotation mechanism configured to prevent rotation in a seconddirection opposite to the first direction when the staples are deployedin tissue. Each D-shaped staple of the device includes a first leg thatis substantially straight, and a second leg that is curved.

The anti-rotation mechanism can take a variety of forms. In one aspectthe anti-rotation mechanism comprises a barb formed on the staple andoriented in a direction to prevent counter-rotation of the staples. Forexample, the anti-rotation mechanism on each staple can comprise a barbis formed on an outer-facing surface of the second leg, which may beoriented towards the first leg. In another aspect the anti-rotationmechanism comprises a coupling element formed on each staple andconfigured to receive a tip of an adjacent staple when deployed suchthat counter-rotation of the staples is prevented. In yet anotheraspect, the anti-rotation mechanism on each staple comprises a hoopformed adjacent to an intersection between the first and second legs andconfigured to receive a tip of the first leg when the staples aredeployed in tissue.

The plurality of staples can be attached to a carrier. The staples canbe frangibly attached to the carrier and they can be arranged inlongitudinal rows on the carrier.

In another embodiment, a surgical fastening device for treating tissuecan comprise a handle, an elongate shaft extending distally from thehandle, and an end effector coupled to a distal end of the elongateshaft, wherein the end effector has a jaw and an anvil pivotallyconnected to the jaw such that the jaw and the anvil being configured toengage tissue therebetween. The fastening device also includes aplurality of fasteners disposed within the jaw, wherein the fastenersare rotatable about a pivot point. Further, the device includes a sledslidable through the jaw such that distal advancement of the sled causeseach of the plurality of fasteners to rotate into tissue engaged betweenthe jaw and the anvil. Each fastener includes an anti-rotation featureconfigured to prevent counter-rotation of the fasteners when deployed intissue.

In one aspect, the anti-rotation feature comprises a barb formed on thefastener and oriented in a direction to prevent counter-rotation of thefasteners. Each fastener can include a straight leg and a curved leg,and the barb can be formed on an outer surface of the curved leg so asto be oriented toward the straight leg. In another aspect, theanti-rotation feature comprises a coupling element formed on eachfastener and configured to receive a tip of an adjacent fastener whendeployed such that counter-rotation of the fasteners is prevented. Byway of example, the coupling element can be in the form of a hoop formedon the fastener.

The fasteners can be attached to a carrier in such a way that they arefrangibly attached thereto. Further, the fasteners can be arranged inlongitudinal rows.

A surgical fastening device for treating tissue comprises an elongateshaft, an end effector coupled to a distal end of the elongate shaft, aplurality of fasteners disposed within the jaw and frangibly coupled toa carrier, a sled configured to advance distally through the jaw tocause each of the plurality of fasteners to rotate into tissue engagedbetween the jaw and the anvil, and a shearing element slidably moveablewithin the jaw to shear each fastener from the carrier, wherein theshearing element is separate from the sled such that the shearingelement is configured to shear the fasteners from the carrier after thefasteners are driven into tissue by the sled. The end effector includesa jaw and an anvil pivotally connected to the jaw, the jaw and the anvilbeing configured to engage tissue therebetween. In one aspect theshearing element is positioned proximal of the sled. In another aspectthe shearing element is coupled to a distal end of the sled. In oneaspect the shearing element includes a plurality of upright wedgesconfigured to shear the fasteners from the carrier.

In one aspect the fastening device further comprises an I-beampositioned proximal of the shearing element and configured to beslidably received within the anvil and the jaw. In another aspect thesled includes a plurality of wedges configured to contact and drive thefasteners into tissue, and a knife for cutting tissue engaged betweenthe jaw and the anvil, and wherein the shearing element is positionedproximal of the wedges and the knife. The shearing element is configuredsuch that it shears the fasteners from the carrier during proximalmovement of the shearing element through the jaw. In one aspect theshearing element is pivotable between a first inactive position and asecond active position, the shearing element shearing the fastenersduring the second active position.

In another aspect a surgical stapling device comprises an end effectorhaving first and second jaws pivotally coupled to one another andconfigured to engage tissue therebetween, a plurality of plasticallydeformable staples frangibly formed on a carrier and disposed within thefirst jaw, wherein the staples are configured to be rotatably deployedinto tissue engaged between the jaws, a wedge configured to slidablyadvance through the first jaw to rotatably drive the staples intotissue, and a shearing element configured to shear the staples from thecarrier after the staples are rotatably deployed into the tissue by thewedge. In one aspect the shearing element is positioned proximal of thewedge. In another aspect the wedge includes a plurality of uprightflanges configured to rotatably drive the staples into tissue, and theshearing element includes a plurality of upright flanges configured toshear the staples from the carrier. The wedge can include a knife forcutting tissue engaged between the first and second jaws, and theshearing element can be positioned proximal of the knife.

In one aspect the shearing element is configured to shear the staplesfrom the carrier during proximal movement of the shearing elementthrough the first jaw. In another aspect the shearing element ispivotable between a first inactive position and a second activeposition, the shearing element shearing the staples during the secondactive position.

A surgical fastening device includes an elongate shaft and an endeffector coupled to a distal end of the elongate shaft. The end effectorincludes first and second opposed jaws coupled to one another andconfigured to engage tissue therebetween. The device also includes astaple cartridge disposed within the first jaw. The staple cartridgealso includes a plurality of staple-receiving recesses formed therein, aplurality of D-shaped staples configured to rotate about a pivot pointinto tissue engaged between the first and second jaws, wherein eachstaple is disposed within a staple-receiving recess, and a plurality ofguide members formed on the cartridge. Each guide member extends from asurface of the cartridge at a location adjacent to a staple-receivingrecess, and each guide member has an inner arcuate surface configured toguide a leg of a staple along an arcuate path and into tissue engagedbetween the first and second jaws. In a further aspect, each guidemember includes opposed sidewalls configured to support and maintainalignment of a staple being rotatably advanced therethrough.

Each guide member is formed on and protrudes outward from atissue-contacting surface of the cartridge. Further, each guide membercan be formed on an inwardly-facing surface of the cartridge, oppositeto a tissue-contacting surface. In one aspect each guide-member issubstantially U-shaped such that the guide member is configured tocontact three sides of a staple being advanced therethrough.

According to another aspect, a surgical stapling device comprises anelongate shaft having an end effector coupled to a distal end thereofand including a cartridge-receiving jaw and an anvil pivotally coupledto the cartridge-receiving jaw. The device also includes a staplecartridge disposed within the cartridge-receiving jaw, wherein thestaple cartridge has a carrier disposed therein with a plurality ofplastically deformable staples formed on the carrier. The staplecartridge also has a deck with a plurality of openings formed therein,wherein each opening is configured to receive one of the plurality ofstaples therethrough. Each opening further has a guide member extendingoutwardly from the deck that is configured to guide a staple beingadvanced through the opening along an arcuate path.

Each guide member can extend outwardly from the deck in a directiontoward the anvil. Alternatively, each guide member can extend outwardlyfrom the deck in a direction away from the anvil.

In one aspect, each guide member includes opposed sidewalls that engageopposed sides of a staple being advanced therethrough. Further, eachguide member can include a curved inner surface that guides the staplesalong a curved pathway.

A surgical fastening device comprises an elongate shaft and an endeffector coupled to a distal end of the elongate shaft. The end effectorincludes a cartridge jaw and an anvil pivotally coupled to one anotherat a pivot point, a cam pin disposed within a cam slot formed in each ofthe cartridge jaw and the anvil, and a closure mechanism proximal to thepivot point. The cam pin is slidable within the cam slots to move theanvil and cartridge jaw between a spaced-apart position and a closedposition in which the cartridge jaw and the anvil are configured toengage tissue therebetween. Further, the closure mechanism is positionedadjacent to a proximal-most end of the anvil and is configured to applya force to the proximal-most end of the anvil to compress tissue engagedbetween the anvil and the cartridge jaw.

The closure mechanism can be in the form of a lobe cam that rotates toapply a force to the proximal-most end of the anvil to move theproximal-most end of the anvil away from the cartridge jaw. The lobe camcan be rotatably disposed within the end effector.

In one aspect the fastening device further comprises a cable coupled tothe lobe cam and configured to rotate the lobe cam to cause the lobe camto apply a force to the proximal-most end of the anvil. The lobe cam caninclude a biasing element that biases the lobe cam to a position inwhich no force is applied to the proximal-most end of the anvil.

The closure mechanism can comprise a wedge configured to apply a forceto the proximal-most end of the anvil to move the proximal-most end ofthe anvil away from the cartridge jaw. In one aspect the wedge isconfigured to advance distally to apply the force to the proximal-mostend of the anvil. The wedge can be formed on a distal end of a pushershaft slidably disposed through the elongate shaft.

According to another aspect, a surgical fastening device comprises ahandle, an elongate shaft extending distally from the handle, and an endeffector coupled to a distal end of the elongate shaft. The end effectorcan include first and second jaws pivotally coupled to one another andmovable about a pivot point between an open position and a closedposition for engaging tissue. The fastener also includes a lobe campositioned proximal to the pivot point and between a proximal-most endof each of the first and second jaws. The lobe cam is rotatable to movethe proximal-most ends of the first and second jaws apart to therebymove the first and second jaws to the closed position. In one aspect thelobe cam can be biased to a position in which the first and second jawsare in the open position, and rotation of the lobe cam overcomes thebias to move the first and second jaws to the closed position.

The surgical fastening device further comprises a cable coupled to thelobe cam and configured to rotate the lobe cam to cause the lobe cam toapply a force to move the first and second jaws to the closed position.The device can be constructed such that a distance between the first andsecond jaws at the pivot point is adjustable.

In yet another aspect, a surgical fastening device comprises a handle,an elongate shaft extending distally from the handle, and an endeffector coupled to a distal end of the elongate shaft. The end effectorincludes first and second jaws pivotally coupled to one another andmovable about a pivot point between an open position and a closedposition for engaging tissue. The device further includes a two-barlinkage coupled to the first and second jaws and configured to apply aforce to the proximal-most end of the first jaw to move theproximal-most end of the first jaw away from the proximal-most end ofthe second jaw.

The two-bar linkage can include a first bar coupled to an actuationshaft slidably disposed through the elongate shaft and a second barcoupled to the first bar and having a pin formed thereon, wherein thepin is slidably disposed within a slot formed in the second jaw.Further, the two-bar linkage is coupled to an actuation shaft that ispulled proximally to cause the two-bar linkage to apply the force to thefirst jaw.

A method for fastening tissue is also provided. The method comprisesinserting an end effector into a body cavity of a patient's body,wherein the end effector being coupled to a distal end of an elongateshaft extending from a handle positioned outside of the patient's body,manipulating the handle of the surgical device to position tissuebetween a cartridge jaw and an anvil of the end effector, actuating aclosure mechanism to advance a pin through cam slots formed in each ofthe cartridge jaw and the anvil to cause the cartridge jaw and the anvilto engage the tissue positioned therebetween, and actuating acompression mechanism to move a proximal-most end of each of the anviland the cartridge jaw away from one another to further compress thetissue engaged therebetween.

In one aspect actuating the compression mechanism comprises rotating alobe cam disposed between a proximal-most end of each of the anvil andthe cartridge jaw. In another aspect actuating the compression mechanismcomprises advancing a wedge distally along the elongate shaft andbetween the proximal-most end of each of the anvil and cartridge jaw. Inyet another aspect actuating the compression mechanism comprisesactuating a two-bar linkage mechanism coupled to the anvil and cartridgejaws.

A surgical fastening device, comprises an elongate shaft and an endeffector coupled to a distal end of the elongate shaft. The end effectorincludes a cartridge jaw and an anvil pivotally coupled to one anotherand configured to engage tissue therebetween. The fastening device alsoincludes a staple cartridge disposed within the cartridge jaw, whereinthe staple cartridge includes a plurality of D-shaped staples configuredto rotate about a pivot point into tissue engaged between the cartridgejaw and the anvil, and at least one adjunct material disposed on atissue-facing surface of the cartridge jaw and configured to receive theplurality of D-shaped staples therethrough when the staples are deployedand frangibly detached from the carrier. Each staple is frangiblycoupled to a carrier.

The at least one adjunct material can comprise a single foam layerdisposed across the entire tissue-facing surface of the cartridge jawand configured to receive each of the plurality of D-shaped staplestherethrough. The at least one adjunct material can also comprise aplurality of adjunct materials, each of the plurality of adjunctmaterials being configured to receive two of the plurality of staplestherethrough for interconnecting the staples. In one aspect the at leastone adjunct material comprises a single adjunct material that spans anentire length and width of the tissue-facing surface of the cartridgejaw. Further, the at least one adjunct material can comprise a firstadjunct material that spans across at least two staple-receivingopenings formed in the tissue-facing surface of the cartridge jaw, andat least one second adjunct material that spans across at least twoother staple-receiving openings formed in the tissue-facing surface ofthe cartridge jaw.

The at least one adjunct material can be at least partially formed froma biologically-derived material. In addition, the adjunct material canbe compressible.

In another aspect, a surgical fastening device comprises an elongateshaft having an end effector at a distal end thereof, wherein the endeffector including first and second jaws pivotally coupled to oneanother and configured to engage tissue therebetween. The fasteningdevice also includes a plurality of D-shaped staples disposed within oneof the first and second jaws, wherein each D-shaped staple beingconfigured to rotate from a first position, in which the staple is fullycontained within the jaw, and a second position in which the stapleprotrudes from the jaw and is configured to engage tissue positionedbetween the first and second jaws. Further, the fastening devicecomprises at least one adjunct material disposed on a tissue-facingsurface of one of the first and second jaws and positioned such that atleast two of the D-shaped staples will protrude therethrough when movedfrom the first position to the second position such that the D-shapedstaples engage both the adjunct material and the tissue.

The plurality of D-shaped staples are frangibly coupled to a carrier,and they are configured to frangibly detach from the carrier duringmovement from the first position to the second position.

The at least one adjunct material can comprise a single foam layerdisposed across an entire tissue-facing surface of the jaw andconfigured to receive each of the plurality of D-shaped staplestherethrough. Alternatively, the at least one adjunct material comprisesa plurality of adjunct materials, each of the plurality of adjunctmaterials is configured to receive two of the plurality of staplestherethrough for interconnecting the staples. In one aspect the at leastone adjunct material comprises a single adjunct material that spans anentire length and width of a tissue-facing surface of the jaw. The atleast one adjunct material can also comprise a first adjunct materialthat spans across at least two staple-receiving openings formed in thetissue-facing surface, and at least one second adjunct material thatspans across at least two other staple-receiving openings formed in thetissue-facing surface.

The at least one adjunct material is at least partially formed from abiologically-derived material, and the adjunct material can becompressible.

A method for stapling tissue is also provided. The method comprisesmanipulating an elongate shaft of a stapling device to position tissuebetween opposed first and second jaws of an end effector, actuating thestapling device to cause the jaws to close and engage the tissuepositioned therebetween, and actuating the stapling device to fire aplurality of D-shaped staples from one of the opposed first and secondjaws, the plurality of D-shaped staples extending through at least oneadjunct material positioned between the opposed first and second jawsand through the tissue engaged between the jaws such that the adjunctmaterial is securely fastened to the tissue by the plurality of D-shapedstaples. In one aspect the D-shaped staples frangibly detach from acarrier when the stapling device is actuated to fire the staples.

The plurality of D-shaped staples are configured to extend through thesame adjunct material. In one aspect the adjunct material comprises atleast first and second separate adjunct materials, wherein first andsecond of the plurality of D-shaped staples extend through the firstadjunct material such that the first and second staples areinterconnected, and wherein third and fourth of the plurality ofD-shaped staples extend through the second adjunct material such thatthe third and fourth staples are interconnected.

A surgical fastening device comprises an elongate shaft and an endeffector coupled to a distal end of the elongate shaft such that the endeffector includes a cartridge jaw and an anvil pivotally coupled to oneanother and configured to engage tissue therebetween. The device alsoincludes a staple cartridge configured to be removably disposed within achannel formed in the cartridge jaw, wherein the staple cartridgeincludes a plurality of staples disposed therein. The device furtherincludes a latch formed on one of the cartridge jaw and the staplecartridge, wherein the latch is configured to extend into acorresponding engagement feature formed in the other one of thecartridge jaw and the staple cartridge when the staple cartridge isfully seated within the cartridge jaw. The latch can protrude radiallyoutward beyond an outer diameter of the elongate shaft and end effectorwhen the latch is not engaged with the corresponding engagement feature.

In one aspect the latch is formed on a proximal portion of the cartridgejaw and the corresponding engagement feature is formed on the staplecartridge. The corresponding engagement feature can comprise a cut-out.In one aspect the latch comprises a deflectable spring-arm configured tosnap into the corresponding engagement feature when the staple cartridgeis fully seated in the cartridge jaw.

The device is constructed such that the plurality of staples in thecartridge are configured to rotate about a pivot point into tissueengaged between the cartridge jaw and the anvil. Further, the pluralityof staples are each frangibly coupled to a carrier.

In another aspect a surgical fastening device comprises an elongateshaft and an end effector coupled to a distal end of the elongate shaftsuch that the end effector includes a cartridge jaw and an anvilpivotally coupled to one another and configured to engage tissuetherebetween. The device also includes a staple cartridge configured tobe removably disposed within a channel formed in the cartridge jaw,wherein the staple cartridge including a plurality of staples disposedtherein. The device further includes a mating element formed on one ofthe staple cartridge and the cartridge jaw and configured to engage acorresponding engagement feature in the other one of the staplecartridge and the cartridge jaw when the staple cartridge is fullyseated within the cartridge jaw. Finally, the device includes at leastone biasing element disposed within a channel formed in the cartridgejaw, wherein the at least one biasing element is configured to bias thestaple cartridge out of the channel in the cartridge jaw when the matingelement is not engaged with the engagement feature.

The mating element can comprise a deflectable spring arm formed on thestaple cartridge, and wherein the corresponding engagement featurecomprises a cut-out formed in the cartridge jaw. Alternatively, themating element comprises first and second deflectable spring arms formedon opposed lateral sides of the staple cartridge, and wherein thecorresponding engagement feature comprises first and second cut-outsformed in opposed lateral sides of the cartridge jaw. In one aspect thebiasing element comprises at least one spring. The at least one springcan be compressed when the staple cartridge is fully seated in thecartridge jaw. In one aspect the biasing element is formed within aproximal portion of the channel in the cartridge jaw.

A method for attaching a staple cartridge to an end effector of astapling device is also provided. The method comprises positioning astaple cartridge in a channel formed within a cartridge jaw of an endeffector of a surgical stapling device, the cartridge jaw having ananvil pivotally coupled thereto, wherein a mating feature on one of thestaple cartridge and the cartridge jaw snaps into a correspondingengagement feature on the other one of the staple cartridge and thecartridge jaw, and wherein a biasing element on the end effector andseparate from the mating feature results in a positive indication to auser when the staple cartridge is not fully seated within the cartridgejaw. The method can further comprise inserting the end effector througha trocar extending through a tissue wall and into a body cavity of apatient, the deflectable spring arm preventing insertion of the endeffector into the body cavity when the staple cartridge is not fullyseated within the cartridge jaw.

In one aspect of the method, the biasing element comprises at least onespring that biases the staple cartridge out of the cartridge jaw whenthe mating element is not engaged with the corresponding engagementfeature such the positive indication comprises misalignment of thestaple cartridge with the cartridge jaw. In another aspect, the biasingelement comprises at least one deflectable spring arm that protrudesradially outwardly from an outer diameter of the end effector to providethe positive indication when the mating element is not engaged with thecorresponding engagement feature.

A surgical stapling device comprises a cartridge jaw, an anvil pivotallyconnected to the cartridge jaw, and a first cartridge configured to bedetachably seated within a channel in the cartridge jaw. The firstcartridge holds a plurality of staples of a first size and includes afirst gap-setting feature defined in an exterior of the first cartridge,wherein a first clamp gap between the cartridge jaw and the anvil is setby the gap-setting feature. The stapling device also includes at leastone cam plate coupled to the cartridge jaw. The cam plate has first andsecond positions, wherein when the cam plate is in the first position atleast one of closure of the anvil and cartridge jaw and firing of thestaples into tissue engaged between the anvil and the jaw is prevented,and wherein the first cartridge moves the cam plate from the firstposition to the second position when the first cartridge is fully seatedwithin the anvil. In one aspect the at least one cam plate is preventedfrom moving from the first position to the second position when thecartridge is not fully seated within the cartridge jaw. Further, the atleast one cam plate includes a central aperture having a height at aproximal end that is greater than a height at a distal end.

The stapling device further comprises a pivot pin constrained within andmovable within the central aperture of the at least one cam plate,wherein the pivot pin interconnects the cartridge jaw and the anvil. Thepivot pin can be movable in both lateral and longitudinal directionswithin the central aperture. In another aspect, a second cartridge canbe configured to be detachably seated within the channel in thecartridge jaw. The second cartridge holds staples of a second size andincludes a second gap-setting feature defined in an exterior of thesecond cartridge, wherein a second clamp gap between the cartridge jawand the anvil is set by the second gap-setting feature, and wherein thefirst clamp gap is different from the second clamp gap.

In another aspect, a surgical fastening device comprises an elongateshaft and an end effector coupled to a distal end of the elongate shaft,wherein the end effector includes a cartridge jaw and an anvil pivotallycoupled to one another and movable between an open position and a closedposition in which tissue can be engaged therebetween. The fasteningdevice also includes a cam pin disposed within a cam slot formed in theend effector, wherein the cam pin having first, second, and thirdpositions within the cam slot, and wherein movement of the cam pinwithin the cam slot between the second and third positions is effectiveto change a distance between a proximal end of each of the cartridge jawand the anvil. The fastening device further includes a staple cartridgeconfigured to be removably disposed within a channel formed in thecartridge jaw and including a plurality of staples disposed therein. Thestaple cartridge is configured to cause the cam pin to move out of thefirst position and into one of the second and third positions when thestaple cartridge is fully seated within the cartridge jaw, and the campin is prevented from moving out of the first position when the staplecartridge is not fully seated within the cartridge jaw. When the cam pinis in the first position, the anvil and cartridge jaw are held in theopen position and prevented from moving to the closed position.Alternatively, when the cam pin is in the first position, the anvil andcartridge jaw are freely movably between the open and closed positions,and actuation of the device to fire staples from the staple cartridge isprevented.

In one aspect the cam slot has a height at a proximal end that isgreater than a height at a distal end of the cam slot. The cam slot canbe formed in at least one shuttle positioned adjacent to a sidewall ofthe cartridge jaw. In one aspect the at least one shuttle is biaseddistally and slidable longitudinally.

A method of attaching a staple cartridge to an end effector of astapling device is also provided. The method comprises positioning astaple cartridge in a channel formed within a cartridge jaw of an endeffector of a surgical stapling device, wherein the cartridge jaw has ananvil pivotally coupled thereto, and the end effector includes a shuttlethat slides proximally from a first position to a second position inresponse to seating of the staple cartridge fully within the channel inthe cartridge jaw. The shuttle prevents at least one of closure of theanvil and the cartridge jaw to engage tissue and firing of staples fromthe cartridge when the shuttle is in the first position and prior to thestaple cartridge being fully seated within the channel in the cartridgejaw.

In one aspect wherein movement of the shuttle from the first position tothe second position causes a pin extending through a central aperture inthe shuttle to move from a first position to a second position. Inanother aspect positioning of the cartridge within the channel in thecartridge jaw moves the pin into one of the second position and a thirdposition, wherein the cartridge jaw and the anvil have a first clamp gapheight when the pin is in the second position, and the cartridge jaw andthe anvil have a second clamp gap height when the pin is in the thirdposition, the second clamp gap height differing from the first clamp gapheight.

According to one aspect of the method, when the pin in the firstposition it prevents pivotal movement of the anvil and the cartridge jawrelative to one another. In another aspect, when the pin in the firstposition it prevents actuation of a firing mechanism to eject aplurality of staples from the staple cartridge. According to the methodwhen the cartridge is positioned within the channel of the cartridge jawit sets a clamp gap between the cartridge jaw and the anvil.

A surgical fastening device comprises an elongate shaft, an end effectorcoupled to a distal end of the elongate shaft, and a cartridge removablyseated within a channel in the cartridge jaw of the end effector. Theend effector includes a cartridge jaw and an anvil pivotally coupled toone another and movable between an open position and a closed positionin which tissue can be engaged therebetween, wherein a distance betweena proximal end of each of the cartridge jaw and the anvil is adjustable.Further, the cartridge includes an anvil coupling member slidablydisposed therein and configured to couple to a drive shaft extendingthrough the elongate shaft for advancing the anvil coupling memberdistally through the end effector. In one aspect a proximal end of theanvil coupling member includes a feature formed therein for receiving acorresponding feature formed in a distal end of the drive shaft. Inanother aspect the anvil coupling member engages and distally advancesthrough a slot formed in the anvil, and a distal end of the anvilincludes an opening formed therein for releasing the anvil couplingmember to allow the anvil to be moved to an open position away from thecartridge jaw.

The anvil coupling member can include a knife formed on a distal-facingsurface thereof for cutting tissue engaged between the cartridge jaw andthe anvil. In addition the drive shaft can include a mating elementformed on a distal end thereof that engages and slides within a slotformed in the cartridge jaw. In one aspect the anvil coupling member isconfigured to pivot away from the anvil when the anvil coupling memberis positioned at a distal-most end of the anvil.

A staple cartridge is provided that comprises a cartridge housing, aplurality of staples disposed within the cartridge housing, wherein theplurality of staples being frangibly detached to a carrier, and an anvilcoupling member slidably disposed within a track formed in thecartridge. The anvil coupling member includes a proximal portion havingan engagement feature on a proximal-facing surface thereof for matingwith a drive shaft, and the anvil coupling member includes a distalportion pivotally coupled to the proximal portion.

The anvil coupling member can include a knife on a distal-facing surfacethereof. Further, the engagement feature can comprise a detent formed inthe proximal-facing surface of the anvil coupling member. In one aspectthe proximal portion includes a pin extending therethrough andprotruding from lateral sides thereof. The pin is configured to engageand slide within a slot formed in an anvil of an end effector of astapling device.

A method for stapling tissue is also provided. The method comprisespositioning a cartridge having a plurality of staples and an anvilcoupling member disposed therein within a first jaw of an end effectorof a surgical stapler. The method also includes engaging tissue betweenthe first jaw and a second jaw of the end effector, and advancing adrive shaft through the surgical stapler such that a distal end of thedrive shaft abuts a proximal end of the anvil coupling member todistally advance the anvil coupling member through the end effector. Theanvil coupling member has a first engagement feature that rides within aslot formed in a second jaw of the end effector, and the drive shaft hasa second engagement feature that rides within a slot formed in the firstjaw.

In one aspect of the method the anvil coupling member includes a knifeon a distal facing surface thereof that cuts the tissue engaged betweenthe first and second jaws. Another feature of the method is that thefirst engagement feature moves out of and releases the second jaw whenthe anvil coupling member reaches a distal-most end of the second jaw.Further, the anvil coupling member pivots away from the second jaw whenthe anvil coupling member is fully distally advanced through the secondjaw, and the method further comprises opening the first and second jawsto release the tissue.

A surgical fastening device comprises a handle housing having anelongate shaft extending distally therefrom, an end effector coupled toa distal end of the elongate shaft, a drive beam disposed within the endeffector and advanceable in a distal direction to drive staples intotissue engaged between the cartridge jaw and the anvil, a drive shaftextending through the elongate shaft and coupled to the drive beam foradvancing the drive beam through the end effector, a first retractionmechanism coupled to the drive shaft and configured to move linearly ina proximal direction to move the drive beam proximally and therebyretract the drive beam, and a second retraction mechanism coupled to thedrive shaft and configured to rotate to drive the drive shaft proximallyand thereby retract the drive beam. The end effector includes acartridge jaw and an anvil pivotally coupled to one another and movablebetween an open position and a closed position in which tissue can beengaged therebetween.

In one aspect the handle housing includes an actuation member having apawl that engages a rack formed on the drive shaft for advancing thedrive shaft distally. The first retraction mechanism comprises at leastone retraction knob extending from the handle housing and slidablewithin an elongate slot formed in the handle housing and extending in aproximal-distal direction. Further, the second retraction mechanismcomprises a gear having at least one tooth formed thereon that engages arack formed on the drive shaft.

The fastening device further comprises a tool configured to removablyengage the gear to cause rotation of the gear. In one aspect the toolcomprises a wrench. In another aspect the handle housing includes anopening formed therein for allowing insertion of the tool therethroughfor coupling with the gear. The fastening device further comprises alever fixedly coupled to the gear and rotatable relative to the housingto rotate the gear. And in another aspect the fastening device furthercomprises a cartridge disposed within the cartridge jaw and containing aplurality of staples frangibly coupled to a carrier.

In another aspect a surgical fastening device comprises a handleassembly including a housing and a movable handle, an elongate shaftextending from the handle assembly, an end effector at a distal end ofthe elongate shaft, the end effector having an anvil and a staplecartridge containing a plurality of staples rotatably deployable intotissue, a drive assembly configured to move relative to the staplecartridge and the anvil to eject the staples from the staple cartridge,and an actuation assembly extending through the housing and the elongateshaft and having a rack formed thereon. The movable handle has a pawlconfigured to engage the rack on the actuation assembly to move theactuation assembly in response to movement of the movable handle,wherein movement of the actuation assembly drives the drive assemblyrelative to the staple cartridge and anvil to eject the staples from thestaple cartridge. The fastening device also has a pair of retractionlevers linearly slidable relative to the housing and coupled to theactuation assembly for retracting the actuation assembly and thus thedrive assembly, and a retraction gear coupled to the rack and rotatablydisposed within the housing such that rotation of the retraction gearretracts the actuation assembly and the drive assembly.

In one aspect the pair of retraction levers are each slidably disposedwithin an elongate slot formed in the housing. In another aspect theretraction gear has at least one tooth formed thereon that engages therack formed on the actuation assembly. The fastening device furthercomprises a tool configured to removably engage the retraction gear tocause rotation of the gear. The tool can comprise a wrench.

In one aspect the housing includes an opening formed therein forallowing insertion of the tool therethrough for coupling with the gear.The fastening device further comprises a lever fixedly coupled to theretraction gear and rotatable relative to the housing to rotate theretraction gear. In another aspect the plurality of staples arefrangibly coupled to a carrier. Further, each of the plurality ofstaples can be D-shaped.

A method for fastening tissue is provided. The method comprises engagingtissue between opposed jaws of an end effector, and advancing a sledthrough the end effector to rotate a plurality of fasteners into thetissue. Each fastener includes an anti-rotation mechanism thatsubstantially prevents counter-rotation of the fastener within thetissue. In one aspect the fasteners plastically deform during rotation,and are frangibly detached from a carrier disposed within the endeffector.

In another aspect a method for fastening tissue is provided, whichincludes engaging tissue between opposed jaws of an end effector, andadvancing a sled and a shearing element through one of the jaws.According to the method the sled causes a plurality of fastenersfrangibly coupled to a carrier to rotate about a pivot point and intothe tissue between the jaws, wherein the fasteners at least partiallyshear at the pivot point, and wherein the shearing element subsequentlyshears the fasteners at the pivot point to separate the fasteners fromthe carrier. In one aspect the shearing element is coupled to a distalend of the sled such that the sled contacts the fasteners prior to theshearing element contacting the fasteners. The sled can include a knifethat cuts the tissue engaged between the jaws.

Another method for fastening tissue comprises engaging tissue betweenopposed jaws of an end effector, and advancing a sled through at leastone of the opposed jaws to rotatably deploy a plurality of fastenersfrom the end effector and into the tissue engaged between the jaws. Eachfastener is advanced through an opening in a cartridge and through aguide member formed adjacent to the opening, wherein each guide memberguides a fastener along an arcuate path and maintaining alignment of thefasteners during deployment. In one aspect each guide member contactsthree sides of the fastener being advanced therethrough.

BRIEF DESCRIPTION OF THE DRAWINGS

This invention will be more fully understood from the following detaileddescription taken in conjunction with the accompanying drawings, inwhich:

FIG. 1 is a perspective view of one embodiment of a surgical deviceconfigured to apply fasteners to tissue and including an end effector,the end effector being in a closed position;

FIG. 2 is a perspective view of the end effector of FIG. 1 in an openposition;

FIG. 3 is a perspective view of the end effector of FIG. 2 with oneembodiment of a cartridge removably coupled thereto;

FIG. 4 is a perspective, partially cross-sectional view of the endeffector and the cartridge of FIG. 3;

FIG. 5 is a perspective view of the cartridge of FIG. 3;

FIG. 6 is another perspective view of the cartridge of FIG. 3;

FIG. 7 is a perspective view of a sled of the cartridge of FIG. 3, thesled including a cutting element, and the cutting element being in afirst position;

FIG. 8 is a perspective view of the sled of FIG. 7 with the cuttingelement in a second position that is different from the first position;

FIG. 9 is a side view of one embodiment of a fastener including ananti-rotation mechanism;

FIG. 10 is a side view of another embodiment of a fastener including ananti-rotation mechanism;

FIG. 11 is a side, partially transparent view of the fastener of FIG. 10deployed in tissue;

FIG. 12 is a side view of yet another embodiment of a fastener includingan anti-rotation mechanism;

FIG. 13 is a side, partially transparent view of the fastener of FIG. 12being deployed in tissue;

FIG. 14 is a side view of an embodiment of a fastener including firstand second anti-rotation mechanisms;

FIG. 15 is a side view of another embodiment of a fastener including ananti-rotation mechanism;

FIG. 16 is a side, partially transparent view of the fastener of FIG. 15deployed in tissue;

FIG. 17 is a perspective view of another embodiment of a fastenerincluding an anti-rotation mechanism;

FIG. 18 is a perspective view of an embodiment of a plurality ofinterconnected deployed fasteners;

FIG. 19 is a perspective view another embodiment of a fastener includinga first anti-rotation mechanism and a second anti-rotation mechanism,with the first anti-rotation mechanism coupled to an adjacent fastener;

FIG. 20 is a perspective view of an embodiment of a cartridge andstaples that can be deployed therefrom in opposite-facing longitudinalrows;

FIG. 21 is a side, partially transparent view of the staples of FIG. 20that face in one direction being deployed from the cartridge with adrive beam engaged with a first sled translating distally through thecartridge;

FIG. 22 is a side, partially transparent view of the first wedge sled ofFIG. 21 at a distal end of the cartridge and passing over a second sled;

FIG. 23 is a side, partially transparent view of the drive beam engagedwith the second sled of FIG. 22 and disengaged from the first sled;

FIG. 24 is a side, partially transparent view of the staples of FIG. 23facing in an opposite direction being deployed from the cartridge withthe drive beam engaged with a second sled translating proximally throughthe cartridge;

FIG. 25 is a perspective view of the drive beam and the first sled ofFIG. 24 coupled together and moving distally, and a perspective view ofsecond sled not coupled to and positioned distal to the drive beam andthe first sled;

FIG. 26 is a perspective view of the drive beam and the first sled ofFIG. 22 coupled together and the first sled passing by the second sled;

FIG. 27 is a perspective view of the drive beam and the second sled ofFIG. 23 coupled together and a perspective view of first sled notcoupled to and positioned distal to the drive beam and the second sled;

FIG. 28 is a perspective view of the drive beam and the second sled ofFIG. 24 coupled together and moving proximally, and a perspective viewof first sled not coupled to and positioned distal to the drive beam andthe second sled;

FIG. 29 is a perspective view of one embodiment of a shearing elementconfigured to couple to a sled and an I-beam and be positionedtherebetween;

FIG. 30 is a perspective view of the shearing element of FIG. 29positioned between and coupled to the sled and the I-beam;

FIG. 31 is a perspective view of the shearing element of FIG. 29 coupledto another embodiment of a sled and to the I-beam of FIG. 29;

FIG. 32 is a perspective view of another embodiment of a shearingelement configured to couple to a sled and an I-beam and be positionedtherebetween;

FIG. 33 is a side cross-sectional view of the shearing element, sled,and I-beam of FIG. 32 firing fasteners from a bottom jaw of an endeffector;

FIG. 34 is a side cross-sectional view of another embodiment of ashearing element, the shearing element being coupled to a sled and anI-beam translating distally through a bottom jaw of an end effector, theshearing element being in a first position;

FIG. 35 is a side cross-sectional view of the shearing element, sled,and I-beam of FIG. 34 translating proximally through the bottom jaw, theshearing element being in a second position that is rotated from thefirst position;

FIG. 36 is a side view of one embodiment of a plurality of fastenerseach including a separation feature and each being frangibly attached toa carrier strip, a sled translating relative to the fasteners and thecarrier and engaging one of the separation features;

FIG. 37 is a side view of the sled and one of the fasteners of FIG. 36;

FIG. 38 is a side view of another embodiment of a plurality of fastenerseach including a separation feature and each being frangibly attached toa carrier strip, a sled translating relative to the fasteners and thecarrier;

FIG. 39 is a perspective view of one embodiment of a cartridge includinga separation feature formed thereon adjacent to a fastener ejectablefrom the cartridge and frangibly attached to a carrier;

FIG. 40 is a perspective view of the fastener of FIG. 39 translatingdistally and engaging the fastener;

FIG. 41 is a perspective view of the separation feature of FIG. 39facilitating separation of the fastener of FIG. 40 from the carrier;

FIG. 42 is a perspective view of another embodiment of a cartridgeincluding a separation feature adjacent to fasteners ejectable from thecartridge and each disposed within a pocket formed in the cartridge;

FIG. 43 is a side cross-sectional view of the separation feature of FIG.42 within a bottom jaw of an end effector, the end effector being in aclosed position;

FIG. 44 is a side view of the end effector of FIG. 43;

FIG. 45 is a side cross-sectional view of the separation feature of FIG.43 within the bottom jaw of the end effector, the end effector being inan open position;

FIG. 46 is a side view of the end effector of FIG. 45;

FIG. 47 is a side view of another embodiment of a cartridge including aseparation feature adjacent to a fastener ejectable from the cartridgeand disposed in a first position within a pocket formed in thecartridge;

FIG. 48 is a side view of the separation feature and fastener of FIG. 47with a sled engaging the fastener and with the fastener moved to asecond position from the first position;

FIG. 49 is a side view of the separation feature and fastener of FIG. 48with the sled engaging the fastener and with the fastener moved to athird position from the second position;

FIG. 50 is a perspective view of the fastener of FIG. 47 engaged withthe sled of FIG. 48;

FIG. 51 is a perspective view of the fastener and sled of FIG. 48;

FIG. 52 is a perspective view from left to right of the fastener andsled of FIG. 50, the fastener and sled of FIG. 51, and the fastener andsled of FIG. 49;

FIG. 53 is a perspective view of another embodiment of a cartridgeincluding a separation feature;

FIG. 54 is a perspective view of yet another embodiment of a cartridgeincluding a separation feature;

FIG. 55 is a perspective view of one embodiment of a fastener thatincludes a camming surface;

FIG. 56 is a perspective view of the fastener of FIG. 55 and anotherembodiment of a cartridge including a separation feature;

FIG. 57 is a perspective view of the fastener and cartridge of FIG. 56with the fastener removably coupled to the separation feature and in afirst position;

FIG. 58 is a perspective view of the fastener and cartridge of FIG. 57with the fastener moved to a second position from the first position;

FIG. 59 is a perspective view of the fastener and cartridge of FIG. 58with the fastener moved to a third position from the second position;

FIG. 60 is a perspective view of another embodiment of a fastener thatincludes a camming surface and another embodiment of a cartridgeincluding a separation feature;

FIG. 61 is a perspective view of the fastener of FIG. 60;

FIG. 62 is a side, partially cross-sectional view of the fastener andcartridge of FIG. 60, the fastener being in a first position;

FIG. 63 is a perspective view of the fastener and cartridge of FIG. 62with the fastener moved to a second position from the first position;

FIG. 64 is a perspective view of the fastener and cartridge of FIG. 63with the fastener moved to a third position from the second position;

FIG. 65 is a perspective view of the fastener and cartridge of FIG. 63with the fastener moved to a fourth position from the third position;

FIG. 66 is a perspective view of one embodiment of a cartridge includinga plurality of guidance features and having a plurality of fastenersdisposed therein;

FIG. 67 is a perspective view of one of the fasteners of FIG. 66 beingdeployed and guided by one of the guidance features;

FIG. 68 is a perspective, partially cross-sectional view of anotherembodiment of a cartridge including a plurality of guidance features andhaving a plurality of fasteners disposed therein;

FIG. 69 is another perspective, partially cross-sectional view of thecartridge of FIG. 68 without the fasteners disposed therein;

FIG. 70 is another perspective, partially cross-sectional view of thecartridge of FIG. 68 with one of the fasteners being deployed and guidedby one of the guidance features;

FIG. 71 is a perspective view of one embodiment of a sled that includesa plurality of guidance features;

FIG. 72 is an end view of the sled of FIG. 71 with a plurality offasteners engaged with the plurality of guidance features;

FIG. 73 is a cross-sectional view of one of the fasteners and one of theguidance features of FIG. 72;

FIG. 74 is a cross-sectional view of one embodiment of a bottom jaw thatincludes a plurality of guidance features, the bottom jaw being part ofan end effector that also includes an upper jaw;

FIG. 75 is a perspective view of the bottom jaw of FIG. 74;

FIG. 76 is a cross-sectional view of another embodiment of a bottom jawthat includes a plurality of guidance features;

FIG. 77 is another cross-sectional view of the bottom jaw of FIG. 76,the bottom jaw being part of an end effector that also includes an upperjaw;

FIG. 78 is a side, partially transparent view of one embodiment of asurgical device including an end effector and a closure mechanism in theform of a lobe cam, the end effector being in an open position;

FIG. 79 is a side, partially transparent view of the device of FIG. 78,the end effector in an intermediate position between open position and aclosed position;

FIG. 80 is a side, partially transparent view of the device of FIG. 79,the end effector being in the closed position;

FIG. 81 is a side, partially cross-sectional view of another embodimentof a surgical device including an end effector and a closure mechanismin the form of a lobe cam, the end effector being in a closed position;

FIG. 82 is a side, partially cross-sectional view of a portion of thedevice of FIG. 81, the end effector being in an open position;

FIG. 83 is a side, partially transparent view of one embodiment of asurgical device including an end effector and a closure mechanism in theform of a wedge, the end effector being in an open position;

FIG. 84 is a side, partially transparent view of the device of FIG. 83,the end effector in an intermediate position between open position and aclosed position;

FIG. 85 is a side, partially transparent view of the device of FIG. 84,the end effector being in the closed position;

FIG. 86 is a side view of one embodiment of a surgical device includingan end effector and a closure mechanism in the form of a two-barlinkage, the end effector being in an open position;

FIG. 87 is a side view of the device of FIG. 86, the end effector beingin a closed position;

FIG. 88 is a side, partially schematic view of a portion of the deviceof FIG. 86;

FIG. 89 is a side, partially schematic view of a portion of the deviceof FIG. 87;

FIG. 90 is a side, partially transparent view of one embodiment of asurgical device including an end effector and a closure mechanism in theform of a rotating element, the end effector being in an open position;

FIG. 91 is a side, partially transparent view of the device of FIG. 90,the end effector being in a closed position;

FIG. 92 is a side, partially transparent view of another embodiment of asurgical device including an end effector and a closure mechanism in theform of a rotating element, the end effector being in an open position;

FIG. 93 is a side, partially transparent view of the device of FIG. 92,the end effector being in a closed position;

FIG. 94 is a side, partially transparent view of the device of FIG. 92,the rotating element being actuated to cause closing of a distal end ofthe end effector;

FIG. 95 is a side, partially transparent view of the device of FIG. 92,the rotating element being actuated to cause closing of a proximal endof the end effector;

FIG. 96 is a perspective view of one embodiment of a surgical deviceincluding an end effector and a closure mechanism in the form of aclosure tube, the end effector being in an open position;

FIG. 97 is a side, partially transparent view of the device of FIG. 96;

FIG. 98 is a side, partially transparent view of the device of FIG. 96,the end effector being in a closed position;

FIG. 99 is a side view of one embodiment of a surgical device includingan end effector and a closure mechanism in the form of a truss, the endeffector being in an open position and the truss being in a collapsedposition;

FIG. 100 is a side view of the device of FIG. 99, the truss being in anexpanded position;

FIG. 101 is a side view of the device of FIG. 100, the end effectorbeing in a closed position;

FIG. 102 is a perspective view of a portion of the device of FIG. 99;

FIG. 103 is a perspective view of a portion of the device of FIG. 100;

FIG. 104 is a cross-sectional front end view of one embodiment of asurgical device including an end effector and a closure mechanism in theform of an external compression member;

FIG. 105 is cross-sectional back end view of the device of FIG. 104;

FIG. 106 is a perspective view of the external compression member ofFIG. 104;

FIG. 107 is a side view of the end effector and the external compressionmember of FIG. 104, the end effector being in an open position;

FIG. 108 is a side view of the end effector and the external compressionmember of FIG. 104, the end effector being in a closed position;

FIG. 109 is an exploded perspective view of one embodiment of a surgicaldevice including an end effector and a closure mechanism in the form ofan internal end effector protrusion;

FIG. 110 is a side, cross-sectional view of the end effector and theclosure mechanism of FIG. 109;

FIG. 111 is a perspective partially cross-sectional view of oneembodiment of a cartridge having an adjunct material disposed thereonand having a plurality of fasteners disposed therein;

FIG. 112 is a side cross-sectional view of a portion of the cartridge ofFIG. 111 with the adjunct material positioned adjacent a tissue;

FIG. 113 is a side cross-sectional view of the cartridge of FIG. 112with a plurality of fasteners ejected therefrom through the adjunctmaterial and into the tissue;

FIG. 114 is a side cross-sectional view of the fasteners, tissue, andadjunct material of FIG. 113;

FIG. 115 is a perspective partially exploded view of another embodimentof a cartridge having an adjunct material disposed thereon and having aplurality of fasteners disposed therein;

FIG. 116 is a side partially transparent view of two of the fasteners ofFIG. 115 advanced through the adjunct material;

FIG. 117 is a side partially transparent view of the fasteners and theadjunct material of FIG. 116, the adjunct material flexing withoutbreaking;

FIG. 118 is a perspective view of another embodiment of an adjunctmaterial having two fasteners disposed therethrough;

FIG. 119 is a perspective partially exploded view of another embodimentof a cartridge having an adjunct material disposed thereon and having aplurality of fasteners disposed therein;

FIG. 120 is a perspective partially exploded view of the adjunctmaterial and two of the fasteners of FIG. 119;

FIG. 121 is a side partially transparent view of two of the fasteners ofFIG. 120 advanced through the adjunct material;

FIG. 122 is a perspective view of two of the fasteners of FIG. 121advanced through the adjunct material;

FIG. 123 is a perspective view of another embodiment of an adjunctmaterial;

FIG. 124 is a perspective view of the adjunct material of FIG. 123having a fastener disposed therethrough;

FIG. 125 is another perspective view of the adjunct material andfastener of FIG. 124;

FIG. 126 is a perspective view of the fastener of FIG. 124;

FIG. 127 is a side partially cross-sectional view of one embodiment of adistal portion of a surgical device configured to removably seat acartridge in an end effector thereof, the cartridge being fully seatedin the end effector;

FIG. 128 is a side partially transparent view of the distal portion ofthe surgical device of FIG. 127, the cartridge not being seated in theend effector;

FIG. 129 is a side cross-sectional view of a portion of the surgicaldevice of FIG. 127;

FIG. 130 is a side cross-sectional view of a portion of the surgicaldevice of FIG. 128;

FIG. 131 is a perspective view of the distal portion of the surgicaldevice of FIG. 128 with the end effector partially inserted into oneembodiment of a trocar;

FIG. 132 is a perspective exploded view of another embodiment of adistal portion of a surgical device configured to removably seat acartridge in an end effector thereof;

FIG. 133 is a top cross-sectional view of the cartridge of FIG. 132fully seated in the end effector;

FIG. 134 is a top cross-sectional view of the cartridge of FIG. 132 notfully seated in the end effector;

FIG. 135 is a side cross-sectional view of another embodiment of adistal portion of a surgical device configured to removably seat acartridge in an end effector thereof, the cartridge being fully seatedin the end effector;

FIG. 136 is a perspective exploded, partially cross-sectional view ofone embodiment of a distal portion of a surgical device including anelongate shaft and an end effector configured to removably couple to theelongate shaft;

FIG. 137 is a side view of one embodiment of a distal portion of asurgical device that includes an end effector and a lockout element, theend effector being in an open position;

FIG. 138 is a side view of the distal portion of the surgical device ofFIG. 137, the end effector being in a closed position;

FIG. 139 is a side view of an anvil of the end effector of FIG. 137;

FIG. 140 is a perspective view of the lockout element of FIG. 137;

FIG. 141 is a side view of the end effector of FIG. 137 adjacent atrocar;

FIG. 142 is a side view of another embodiment of a lockout element, thelockout element having a pivot pin in an upper proximal portion thereof;

FIG. 143 is another side view of the lockout element and pivot pin ofFIG. 142, the pivot pin being in a lower proximal portion thereof;

FIG. 144 is a side cross-sectional view of another embodiment of adistal portion of a surgical device that includes an end effector and alockout element, a cartridge being fully seated in the end effector;

FIG. 145 is another side cross-sectional view of the end effector, thecartridge not being fully seated in the end effector;

FIG. 146 is a perspective exploded view of another embodiment of adistal portion of a surgical device that includes an end effector and alockout element;

FIG. 147 is a side cross-sectional view of the end effector and lockoutelement of FIG. 146, a cartridge not being fully seated in the endeffector;

FIG. 148 is another side cross-sectional view of the end effector andlockout element of FIG. 146, the cartridge being fully seated in the endeffector;

FIG. 149 is a perspective view of one embodiment of a cartridgeincluding an anvil coupling member;

FIG. 150 is a perspective exploded view of the cartridge of FIG. 149 anda distal portion of a surgical device configured to releasably andreplaceable seat the cartridge;

FIG. 151 is a perspective view of the cartridge and the distal portionof the surgical device of FIG. 150, the cartridge partially seatedwithin the distal portion;

FIG. 152 is a side cross-sectional view of the distal portion of thedevice of FIG. 151, the cartridge being fully seated therein;

FIG. 153 is a side cross-sectional view of another embodiment of acartridge including an anvil coupling member;

FIG. 154 is a perspective exploded view of one embodiment of a cartridgeincluding a shim and a cartridge jaw configured to releasably andreplaceably seat the cartridge therein;

FIG. 155 is a side cross-sectional view of the cartridge of FIG. 154seated in the cartridge jaw, the cartridge jaw being coupled to ananvil;

FIG. 156 is a side cross-sectional view of another embodiment of acartridge seated in a cartridge jaw, the cartridge jaw being coupled toan anvil;

FIG. 157 is a side cross-sectional view of another embodiment of acartridge including a shim seated in a cartridge jaw, the cartridge jawbeing coupled to an anvil;

FIG. 158 is a side view of first, second, and third embodiments of acutting element each configured to removably couple to an I-beam;

FIG. 159 is a side partially transparent view of the second cuttingelement of FIG. 158 coupled to the I-beam;

FIG. 160 is a perspective exploded view of another embodiments of acutting element configured to removably couple to the I-beam of FIG.158;

FIG. 161 is a perspective view of the cutting element of FIG. 160removably coupled to the I-beam;

FIG. 162 is a side partially transparent view of the second cuttingelement and I-beam of FIG. 159 and one embodiment of a push rod;

FIG. 163 is a perspective view of the second cutting element, I-beam,and push rod of FIG. 162;

FIG. 164 is a perspective view of the second cutting element and theI-beam removably coupled to the push rod of FIG. 163;

FIG. 165 is a side view of first, second, and third embodiments of acartridge configured to removably couple to an I-beam;

FIG. 166 is a perspective view of a distal portion of the I-beam of FIG.165;

FIG. 167 is a perspective view of the second cartridge of FIG. 165removably coupled to the I-beam, the second cartridge being partiallyseated in an end effector;

FIG. 168 is a side cross-sectional view of the second cartridge of FIG.167 removably coupled to the I-beam and fully seated in the endeffector;

FIG. 169 is a perspective view of one embodiment of a surgical devicehaving a mechanism configured to retract a drive shaft;

FIG. 170 is a schematic view of components within a handle portion ofthe device shown in FIG. 169, illustrating one embodiment of aretraction mechanism;

FIG. 171 is a schematic view of components within a handle portion ofthe device shown in FIG. 169, illustrating another embodiment of aretraction mechanism;

FIG. 172 is a detailed view of an indicator shown on the device of FIG.169;

FIG. 173 is a schematic view of a sled mechanism, in various positions,for counter rotating partially fired fasteners;

FIG. 174 is a perspective view of a cutting element configured to berotated between operative and non-operative conditions;

FIG. 175 is a perspective view of the cutting element of FIG. 174engaged by a drive beam in a non-operative condition prior to firing;

FIG. 176 is a perspective view of the cutting element of FIG. 174engaged by a drive beam in an operative condition;

FIG. 177 is a perspective view of the cutting element of FIG. 174engaged by a drive beam in a non-operative condition followingpositioning in an operative condition;

FIG. 178 is a perspective view of a surgical device including amechanism that audibly indicates the end of a closing stroke;

FIG. 179 is a perspective view of a portion of the audible indicatormechanism of FIG. 178 before and after reaching the end of a closingstroke, with an indication of an audible signal upon reaching the end ofthe stroke;

FIG. 180 is a perspective cross-sectional partially transparent view ofone embodiment of an articulation joint, the articulation joint being inan articulated position;

FIG. 181 is a perspective cross-sectional partially transparent view ofanother embodiment of an articulation joint, the articulation jointbeing in an articulated position;

FIG. 182 is a perspective cross-sectional partially transparent view ofanother embodiment of an articulation joint, the articulation jointbeing in an articulated position;

FIG. 183 is a cross-sectional view of the articulation joint of FIG.182;

FIG. 184 is an end cross-sectional partially transparent view of anotherembodiment of an articulation joint;

FIG. 185 is an end cross-sectional view of a portion of the articulationjoint of FIG. 184;

FIG. 186 is a perspective cross-sectional partially transparent view ofanother embodiment of an articulation joint, the articulation jointbeing in an unarticulated position;

FIG. 187 is another perspective cross-sectional partially transparentview of the articulation joint of FIG. 186, the articulation joint beingin an articulated position; and

FIG. 188 is a perspective cross-sectional partially transparent view ofthe articulation joint of FIG. 187 without a casing thereof and with aplurality of bands disposed therethrough.

DETAILED DESCRIPTION

Certain exemplary embodiments will now be described to provide anoverall understanding of the principles of the structure, function,manufacture, and use of the devices and methods disclosed herein. One ormore examples of these embodiments are illustrated in the accompanyingdrawings. Those skilled in the art will understand that the devices andmethods specifically described herein and illustrated in theaccompanying drawings are non-limiting exemplary embodiments and thatthe scope of the present invention is defined solely by the claims. Thefeatures illustrated or described in connection with one exemplaryembodiment may be combined with the features of other embodiments. Suchmodifications and variations are intended to be included within thescope of the present invention.

Further, in the present disclosure, like-named components of theembodiments generally have similar features, and thus within aparticular embodiment each feature of each like-named component is notnecessarily fully elaborated upon. Additionally, to the extent thatlinear or circular dimensions are used in the description of thedisclosed systems, devices, and methods, such dimensions are notintended to limit the types of shapes that can be used in conjunctionwith such systems, devices, and methods. A person skilled in the artwill recognize that an equivalent to such linear and circular dimensionscan easily be determined for any geometric shape. Sizes and shapes ofthe systems and devices, and the components thereof, can depend at leaston the anatomy of the subject in which the systems and devices will beused, the size and shape of components with which the systems anddevices will be used, and the methods and procedures in which thesystems and devices will be used.

It will be appreciated that the terms “proximal” and “distal” are usedherein with reference to a user, such as a clinician, gripping a handleof an instrument. Other spatial terms such as “front” and “back”similarly correspond respectively to distal and proximal. It will befurther appreciated that for convenience and clarity, spatial terms suchas “vertical” and “horizontal” are used herein with respect to thedrawings. However, surgical instruments are used in many orientationsand positions, and these spatial terms are not intended to be limitingand absolute.

FIG. 1 illustrates one embodiment of a surgical device 1100 that can beconfigured to apply staples to tissue. The device 1100 in thisillustrated embodiment includes a linear stapler configured to applylinear rows of staples. Other embodiments of surgical devices that canbe configured to apply staples to tissue are described in U.S. Pat. No.5,465,895 entitled “Surgical Stapler Instrument” filed Feb. 3, 1994,U.S. Pat. No. 7,000,818 entitled “Surgical Stapling Instrument HavingSeparate Distinct Closing And Firing Systems” filed May 20, 2003, U.S.Pat. No. 7,669,746 entitled “Staple Cartridges For Forming StaplesHaving Differing Formed Staple Heights” filed on Aug. 31, 2005, and U.S.Pat. Pub. No. 2014/0175146 entitled “Microcutter Stapling ApparatusClamp And Deploy Mechanisms Systems And Methods” filed Dec. 19, 2013,which are hereby incorporated by reference in their entireties.

Referring again to FIG. 1, the device 1100 can include a proximal handleportion 1102 having an elongate shaft 1104 extending distally therefrom.As also shown in FIG. 2 and FIG. 3, the shaft 1104 can have an endeffector 1106 coupled to a distal end thereof. The end effector 1106 canbe coupled to the shaft 1104 at a pivot joint 1108. A proximal end ofthe end effector 1106 can be pivotally coupled to the joint 1108 at adistal end of the shaft 1104. The end effector 1106 in this illustratedembodiment includes a tissue grasper having a pair of opposed first andsecond jaws 1110 a, 1110 b configured to move between open and closedpositions. The first jaw is also referred to herein as a “bottom jaw”and a “cartridge jaw,” and the second jaw is also referred to herein asan “upper jaw” and an “anvil.” As discussed further below, the handleportion 1102 can be configured to be manipulated to effect the openingand closing of the opposed jaws 1110 a, 1110 b, e.g., movement of one orboth the jaws 1110 a, 1110 b about the pivot joint 1108, and the handleportion 1102 can be configured to be manipulated to effect the firing ofstaples (not shown) from a one of the jaws 1110 a, 1110 b, e.g., abottom or cartridge one of the jaws 1110 a. The staple firing can beindependent of the opening and closing of the jaws 1110 a, 1110 b.

The handle portion 1102 can have a variety of sizes, shapes, andconfigurations. The handle portion 1102 can include a main housing 1121,which can house a variety of elements therein and can have some elementsaccessible outside thereof, such as a movable trigger 1122 and astationary handle 1124. The movable trigger 1122 can be configured to bemanually manipulated to move the movable trigger 1122 relative to thestationary handle 1124 so as to, e.g., effect closing of the jaws 1110a, 1110 b.

The shaft 1104 can have a variety of sizes, shapes, and configurations.In an exemplary embodiment, the shaft 1104 can be rigid, e.g., made froma generally non-bendable material such as a metal (e.g., stainlesssteel, titanium, etc.) or a hard polymer. In other embodiments, theshaft 1104 can be configured to bend, such as being made from agenerally flexible material, by including one or more articulationregions, etc. The shaft 1104 can have any longitudinal length, althoughin an exemplary embodiment it can be long enough to allow the handleportion 1102 to be manipulated outside a patient's body while the shaft1104 extends through an opening in the body with the end effector 1106disposed within a body cavity. In this way, the end effector 1106 can beeasily manipulated when the device 1100 is in use during a surgicalprocedure. The shaft 1104 can have any diameter. For example, theshaft's diameter can be less than or equal to about 10 mm, e.g., lessthan or equal to about 7 mm, less than or equal to about 5 mm, etc.,which can allow for insertion of the shaft 1104 through an minimallyinvasive access device, e.g., a trocar, a cannula, a multiport accessdevice, etc., such as during a laparoscopic surgical procedure. The endeffector 1106 coupled to the shaft's distal end can have a diameterequal to or less than the shaft's diameter, at least when the jaws 1110a, 1110 b are in the closed position, which can facilitate insertion ofthe device's distal portion into a patient's body.

The end effector 1106 can have a variety of sizes, shapes, andconfigurations. In an exemplary embodiment, the end effector 1106 can berigid. As shown in FIG. 2 and FIG. 3, the end effector 1106 includingthe first and second jaws 1110 a, 1110 b can be disposed at a distal endof the surgical device 1100. As in this illustrated embodiment, when thejaws 1110 a, 1110 b move between the open and closed positions, thesecond jaw 1110 b can be configured to remain stationary relative to theshaft 1104, and the first jaw 1110 a can be configured to move relativeto the shaft 1104 and the second jaw 1110 b by pivoting at the pivotjoint 1108.

The end effector 1106 can be configured to releasably and replaceablyseat a cartridge 1112 therein, as shown in FIG. 3 and FIG. 4. In thisway, when the staples have been fired from the cartridge 1112, thecartridge 1112 can be removed from the second jaw 1110 b and,optionally, replaced with another cartridge having another plurality ofstaples disposed therein. FIG. 2 shows the end effector 1106 without thecartridge 1112 seated therein. The end effector 1106 can be configuredto receive the cartridge 1112 in the first jaw 1110 a thereof, e.g., ina channel formed in the first jaw 1110 a. The first jaw 1110 a can beconfigured to seat cartridges of different sizes, thereby facilitatingversatility of the device 1100.

The cartridge 1112 can have a variety of sizes, shapes, andconfigurations, as will be appreciated by a person skilled in the art.As shown in FIG. 4, FIG. 5, and FIG. 6, the cartridge 1112 can include asled 1120 and can have a plurality of staples 1116 disposed therein. Thesled 1120 is also illustrated in FIG. 7 and FIG. 8. The cartridge 1112can include a plurality openings 1114 formed in a tissue engagingsurface 1118 thereof, as shown in FIG. 3, FIG. 5, and FIG. 6. Thestaples 1116 disposed in the cartridge 1112 can be configured to beejected from the cartridge 1112 through the openings 1114, e.g., onestaple 1116 out of each opening 1114 (as in this illustratedembodiment), two staples out of each opening 1114, etc. The openings1114 can define staple-receiving recesses of the cartridge 1112 in whichthe staples 1116 are seated prior to being ejected from the cartridge1112.

The staples 1116 can have a variety of sizes, shapes, andconfigurations. In this illustrated embodiment, the staples 1116 eachhave a D-shape and include a first leg that is substantially straightand a second leg that is curved. A person skilled in the art willappreciate that the first leg may not be precisely straight, e.g., dueto manufacturing tolerances, but nevertheless be considered to besubstantially straight. Each of the staples 1116 can be configured to beplastically deformable such that the staples 1116 can each be configuredto change shape, such as when the staple 1116 is pressed against atissue engaging surface (not shown) of the first jaw 1110 a that facesthe tissue engaging surface 1118 of the second jaw 1110 b, whileremaining a single unit, e.g., without either of the first and secondlegs breaking. A gap of space can exist between a terminal end of thefirst leg and a terminal end of the second leg. In other words, the “D”shape can have a gap therein. The gap of space can facilitate plasticdeformation of the staple 1116.

The staples 1116 can each be frangibly attached to a carrier 1126, alsoreferred to herein as a “carrier strip,” disposed within the cartridge1112. The staples 1116 can be frangibly attached to the carrier 1126 by,e.g., being stamped together with the carrier 1126 such that the staples1116 and the carrier 1126 forms a single piece. The staples 1116 caneach be configured to detach from the carrier 1126 when fired from thecartridge 1112. In some embodiments, some or all of the staples 1116 canbe frangibly attached to another element, such as another elementdisposed within the cartridge 1112, an inner surface of the cartridge1112, the tissue-engaging surface 1118 of the cartridge 1112, etc. Thecarrier 1126 can be fixedly attached to an upper surface of one or morerails 1128 defined by the cartridge 1112. The carrier 1126 can beconfigured to remain stationary relative to the cartridge 1112.

As shown in FIG. 3, FIG. 5, and FIG. 6, the cartridge 1112 can have alongitudinal slot 1130 formed therein. The longitudinal slot 1130 canextend along a substantially flat central portion 1118 f of thetissue-engaging surface 1118. The slot 1130 can be configured to have acutting element such as a knife (not shown) extend therethrough so as tobe configured to cut tissue engaged by the tissue-engaging surface 1118,as discussed further below. The openings 1114 can be formed in angledportions 1118 a of the tissue-engaging surface 1118 on both sides of theslot 1130, as shown in FIG. 3, FIG. 5, and FIG. 6. In some embodiments,the tissue-engaging surface 1118 can be substantially flat, e.g., nothave angled portions, while in other embodiments, the tissue-engagingsurface 1118 can be angled, e.g., not have any substantially flatportions.

As shown in FIG. 5 and FIG. 6, the cartridge 1112 can include agap-setting feature 1142 configured to set of gap of space between thefirst and second jaws 1110 a, 1110 b when the jaws 1110 a, 1110 b areclosed and the cartridge 1112 is seated in the second jaw 1110 b. Inthis way, the gap-setting feature 1142 can be configured to define aminimum distance between the facing tissue-engaging surfaces of thefirst and second jaws 1110 a, 1110 b. The gap-setting feature 1142 canhave a variety of sizes, shapes, and configurations. As in thisillustrated embodiment, the gap-setting feature 1142 can include anindentation inward toward a lateral center of the cartridge 1112, wherea portion of a lateral edge of the cartridge 1112 immediately proximalto the gap-setting feature 1142 is located laterally inward relative toa portion of a lateral edge of the cartridge 1112 located immediatelydistal to the gap-setting feature 1142.

The sled 1120 of the cartridge 1112 can have a variety of sizes, shapes,and configurations. The sled 1120 can be configured to translatelongitudinally along the cartridge 1112 to cause deployment of thestaples 1116 therefrom and to cause tissue engaged by the end effector1106 to be cut with the cutting element extending through the slot 1130.The staples 1116 can be arranged longitudinally in the cartridge 1112,as shown in FIG. 4, and the sled 1120 can be configured to sequentiallyengage the longitudinally arranged staples 1116 as the sled 1120translates longitudinally. As illustrated in FIG. 7 and FIG. 8, the sled1120 can include a plurality of wedges 1136 and can include a cuttingelement 1134, which in this illustrated embodiment includes a knife witha blade 1132. The sled 1120 in this illustrated embodiment includes fourwedges 1136 but the sled 1120 can include another number of wedges 1136as appropriate for the arrangement of the staples 1116 in the cartridge1112. Each of the wedges 1136 can have a shape configured to cause thestaples 1116 contacted by that wedge 1136 to move upward toward thesecond jaw 1110 b through the openings 1114 and deform against thesecond jaw 1110 b. As shown in FIG. 6, the cartridge 1112 can include aplurality of longitudinal slots 1150 formed therein, each of the slots1150 being configured to slidably receive one of the wedges 1136therein. The slots 1150 can facilitate consistent, straight movement ofthe wedges 1136 through the cartridge 1112 to help ensure properengagement of the wedges 1136 with the staples 1116.

Each of the wedges 1136 can be attached to a base 1138 of the sled 1120and can be in a fixed position relative thereto. The base 1138 can havea guide element 1139 extending generally downward therefrom. The guideelement 1139 can be configured to slide within a channel formed in thecartridge 1112 that includes the sled 1120. The cutting element 1134 canalso be attached to the base 1138, but the cutting element 1134 can beconfigured to move relative to the base 1138. The cutting element 1134can be substantially laterally centered in the base 1138, which canfacilitate substantially central positioning of the cutting element 1134relative to tissue engaged by the end effector 1106.

The cutting element 1134 can be configured to be movable relative to aremainder of the sled 1120 between a first position, shown in FIG. 7,and a second position, shown in FIG. 6 and FIG. 8. The first positioncan be an initial position of the cutting element 1134. In the firstposition, also referred to herein as a “stowed position,” the blade 1132can be generally obscured, e.g., oriented generally downward as shown inthe embodiment of FIG. 4, FIG. 5, FIG. 6, and FIG. 7, which can helpprevent the blade 1132 from inadvertent cutting, such as accidentallycutting a user of the device 1100 during seating of the cartridge 1120within the end effector 1104 and/or premature cutting of tissue engagedby the end effector 1104. The base 1138 can have a cavity 1144 formedtherein, as shown in FIG. 6, which can be configured to seat the cuttingelement 1134 at least partially therein when the cutting element 1134 isin the first position. In the second position, also referred to hereinas an “upright position,” the blade 1132 can be generally unobscured andfacing a distal direction as shown in the embodiment of FIG. 6 and FIG.8, which can allow the blade 1132 to extend through the slot 1130 andcut tissue engaged by the end effector 1106.

The sled 1120 can include a pivot member 1140 configured to facilitatemovement of the cutting element 1134 relative to the remainder of thesled 1120. The pivot member 1140 can have a variety of sizes, shapes,and configurations. The pivot member 1140 can be attached to the cuttingelement 1134 such that engagement of the pivot member 1140 can cause thecutting element 1134 to pivot about a pivot point so as to move relativeto the remainder of the sled. As in this illustrated embodiment thepivot member 1140 can include two separate pins extending laterally fromopposite sides of the cutting element 1134. In other embodiments, thepivot member 1140 can include a single pin extending through the cuttingelement 1134 to extend laterally from opposite sides therefrom, a singlepin extending laterally from one side of the cutting element 1134, etc.At the pivot point, the sled 1120 can include a pivot axle 1146extending laterally from the cutting element 1134, and can include anaxle cavity 1148 formed in the base 1138 and configured to receive thepivot axle 1146 therein.

The surgical devices described herein can be used in a variety ofsurgical procedures. In an exemplary embodiment, the procedure can be aminimally invasive procedure in which the surgical device can beadvanced into a body of a patient through a relatively small opening inthe patient. In a minimally invasive surgical procedure, one or moreintroducer devices (not shown), e.g., a cannula, a trocar, etc., can beadvanced through an opening in the patient to provide access to asurgical site. A person skilled in the art will appreciate that one ormore viewing devices, e.g., a scoping device such as an endoscope, canbe advanced into the body through the incision or through anotheropening, e.g., another incision or a natural orifice, to providevisualization of the surgical site from outside the body. As will beappreciated by a person skilled in the art, the surgical device can beadvanced into the patient's body in a variety of ways, such as by beinginserted transorally therein, inserted through an introducer device,inserted through a scoping device, inserted directly through anincision, etc. Although the following embodiment of use of a surgicaldevice in a surgical procedure is described with respect to the device1100 of FIG. 1, any of the surgical devices described herein can besimilarly used.

The surgical devices described herein can have any one or morevariations to facilitate effective use of the device. Examples of suchvariations are described further below.

In some embodiments, a surgical device such as the above-mentionedsurgical device 1100 can be configured to stabilize fastenerspost-deployment. In general, the fasteners can be configured to resistcounter rotation after being deployed. Fasteners can have a tendency toshift position relative to tissue that the fasteners are securing. Theposition shifting can be caused by any one or more factors, such as atype of the tissue, a thickness of the tissue, a shape of the fasteners(e.g., a curved shape thereof), and a strength of a bias urging afastener into a certain position or configuration. The position shiftingcan take the form of counter rotation, in which the fastener rotates ina direction opposite to a direction in which the fastener was deployedinto the tissue. This counter rotation can reduce the fastener'seffectiveness in fastening the tissue because the fastener is “slipping”out of the tissue and/or reducing its hold on the tissue as a result ofthe counter rotation. The adverse effects of counter rotations can beexacerbated when, as in typical surgical procedures that use fasteners,a plurality of fasteners, all of which may all counter rotate to varyingdegrees, are deployed in tissue. The adverse effects of counterrotations can be exacerbated when tissue is relatively thick such thatstaples may not close to a great extent when deployed in the tissue.Fasteners being configured to resist counter rotation can help keep thestaples secured in tissue into which the staples have been deployed,thereby helping to keep the tissue securely fastened and/or facilitatingeffective treatment of the tissue.

A fastener can be configured to resist counter rotation in a variety ofways. In the embodiments described below, staples are used as examplesof fasteners, but as will be appreciated by a person skilled in the art,other types of fasteners can be similarly configured and used.

In some embodiments, a staple can include one or more anti-rotationmechanisms configured to resist counter rotation of the staple when thestaple is deployed in tissue. FIG. 9 illustrates one embodiment of astaple 1000 that includes one or more anti-rotation mechanisms 1008configured to resist counter rotation. The staple 1000 in thisillustrated embodiment is generally configured like the previouslydescribed staples 1116 and has a D-shape with a pointed tip 1002, afirst leg 1004 that is substantially straight and a second leg 1006 thatis curved. The pointed tip 1002 can be a terminal end of the second leg1006, as in this illustrated embodiment.

The staple 1000 can include one or more anti-rotation mechanisms 1008,which in this illustrated embodiment includes a barb 1008. Thisillustrated embodiment includes only one barb 1008, but the staple 1000can include one or more barbs 1008 that are substantially identical toone another. The barb 1008 can be located in a variety of locations onthe staple 1000. As in this illustrated embodiment, the one or morebarbs 1008 can be formed on an inner-facing surface of the second leg1006 at the pointed tip 1002. The barb 1008 can be oriented in a firstdirection 1010 that is opposite to a second direction 1012 in which thepointed tip 1002 points. The second direction 1012 can be the directionin which the staple 1000 is deployed into tissue, with the pointed tip1002 leading the staple 1000 into the tissue. When the staple 1000 isdeployed in the tissue, the barb 1008 can thus be configured to preventcounter rotation of the staple 1000 therein, thereby helping to retainthe staple securely within the tissue.

The barb 1008 can have a variety of sizes. In an exemplary embodiment,the barb 1008 can have a maximum diameter 1014 is less than orsubstantially equal to a maximum diameter 1016 of the second leg 1006.In this way, a hole created by the barb 1008 when the barb 1008penetrates into tissue can be less than or substantially equal to a holecreated by the second leg 1006 when the second leg 1006 passes throughthe tissue, thereby helping to reducing any potential hemostasis issuesthat may arise from the barb 1008. The second leg 1006 can be taperedtoward the pointed tip 1002 such that the maximum diameter 1016 of thesecond leg 1006 is adjacent a terminal end thereof that is opposite thepointed tip 1002.

FIG. 10 and FIG. 11 illustrate another embodiment of a staple 1016 thatincludes one or more anti-rotation mechanisms 1018 configured to resistcounter rotation. The staple 1016 and the one or more anti-rotationmechanisms 1018, e.g., one or more barbs 1018, can be generallyconfigured and used similar to the staple 1000 and the one or more barbs1008, respectively, of FIG. 9. The one or more barbs 1018 in thisillustrated embodiment, however, are formed in an intermediate portionof the staple's second leg 1020 between proximal and distal endsthereof, and the one or more barbs 1018 are formed on an outer-facingsurface of a second leg 1020 of the staple 1016 that includes a pointedtip 1024 of the staple 1016 and that is connected to a first leg 1022 ofthe staple 1016.

FIG. 11 illustrates an embodiment of the staple 1016 as deployed in atissue 1026. The staple 1016 can be deployed into the tissue 1026, e.g.,fired from a cartridge such as the above-mentioned cartridge 1112, in afirst direction 1028. The one or more barbs 1018 can be oriented in asecond direction 1030 that is opposite to the first direction 1028,thereby helping to secure the staple 1016 to the tissue 1026 and helpingto prevent counter rotation of the staple 1016 within the tissue 1026.The one or more barbs 1018 can be formed in the second leg'sintermediate portion at a location substantially where the staple 1016exits the tissue 1026, as in this illustrated embodiment. An exteriorsurface of the tissue 1026 can cooperate with the one or more barbs 1018at such a location to help prevent counter rotation of the staple 1018,e.g., help prevent the staple 1016 from rotating in the second direction1030 after being deployed in the tissue 1026.

In another embodiment, the one or more barbs can be formed on aninner-facing surface of the second leg in addition to or in alternativeto the one or more barbs formed on the outer-facing surface of thesecond leg. FIG. 12 illustrates such an embodiment of a staple 1016 awith one or more barbs 1018 a formed on an inner-facing surface of asecond leg 1020 a of the staple 1016 a. The staple 1016 a and the one ormore anti-rotation mechanisms 1018 a can be generally configured andused similar to the staple 1000 and the one or more barbs 1008,respectively, of FIG. 9. FIG. 13 illustrates an embodiment of the staple1016 a being deployed in a tissue 1026 a by being pushed by a wedge 1027of a sled so as to rotate the staple 1016 a in a direction of an arrow1029. FIG. 14 illustrates another embodiment of a staple 1016 b with oneor more barbs 1018 b formed on an inner-facing surface of a second leg1020 b of the staple 1016 b. The staple 1016 b is like the staple 1016 aof FIG. 12 except the staple 1016 b of FIG. 14 includes at least onesecond anti-rotation mechanism 1017 on an outer-facing surface of thesecond leg 1020 b. The at least one second anti-rotation mechanism 1017in this illustrated embodiment include a plurality of spikes extendingoutward from the outer-facing surface of the second leg 1020 b.

FIG. 15 and FIG. 16 illustrate another embodiment of a staple 1032 thatincludes one or more anti-rotation mechanisms 1034 configured to resistcounter rotation. The staple 1032 and the one or more anti-rotationmechanisms 1034, e.g., one or more barbs 1034, can be generallyconfigured and used similar to the staple 1000 and the one or more barbs1008, respectively, of FIG. 9. The one or more barbs 1034 in thisillustrated embodiment, however, are formed on an outer-facing surfaceof a second leg 1036 of the staple 1032 closer to a first leg 1037 ofthe staple 1032 than in the FIG. 9 embodiment, and are formed adjacent aterminal end of the second leg 1036 that is opposite to a terminal endthereof that includes a pointed tip 1038. In another embodiment, the oneor more barbs can be formed on an inner-facing surface of the second leg1036 in addition to or in alternative to the one or more barbs 1034formed on the outer-facing surface of the second leg 1036.

FIG. 16 illustrates an embodiment of the staple 1032 deployed in atissue 1040. The one or more barbs 1034 of the staple 1032 can beoriented similar to the one or more barbs 1026 of FIG. 10 and FIG. 12 soas to be oriented in a direction that is opposite to a direction inwhich the staple 1032 was deployed into the tissue 1040. The one or morebarbs 1034 can be formed on the second leg 1036 at a location disposedwithin the tissue 1040 when the staple 1032 is within the tissue 1040,as in this illustrated embodiment. The tissue 1040 can thus completelysurround the one or more barbs 1034 so as to help the one or more barbs1034 prevent counter rotation.

In some embodiments, an anti-rotation mechanism of a first staple can beconfigured to engage a second staple deployed adjacently thereto intissue. The anti-rotation mechanism can be configured to help preventcounter rotation of the first and second staples. In an exemplaryembodiment, an anti-rotation mechanism of a staple configured to engagean adjacent staple can be in the form of a coupling element configuredto receive a pointed tip of the adjacent staple when both of the staplesare deployed in tissue.

FIG. 17 illustrates one embodiment of a staple 1042 that includes ananti-rotation mechanism 1044 in the form of a coupling elementconfigured to engage an adjacently deployed staple. The staple 1042 inthis illustrated embodiment is generally configured and used like thepreviously described staples 1116 and has a D-shape with a pointed tip1046, a first leg 1048 that is substantially straight and a second leg1050 that is curved. The pointed tip 1046 can be a first terminal end ofthe second leg 1050, as in this illustrated embodiment. Theanti-rotation mechanism 1044 can be formed on an outer-facing surface ofthe staple 1042 and can be located at a junction of the first and secondlegs 1048, 1050. The anti-rotation mechanism 1044 can include a ring orhoop configured to receive a pointed tip of an adjacent staple therein.The pointed tip can extend partially or all the way through a hole 1052defined by the anti-rotation mechanism 1044. The anti-rotation mechanism1044 having the adjacent staple's tip at least partially captured by theanti-rotation mechanism 1044 can help prevent counter rotation of thestaple 1042 as well as the adjacent staple engaged by the staple 1042.Because the staple 1042 can be rotated to be deployed in tissue and canbe one of a plurality of staples deployed in a longitudinal row, asdiscussed herein, the staple's tip 1046 can rotate into a previouslydeployed staple's anti-rotation mechanism. In this way, staples deployedin the longitudinal row can all be interconnected with one another viathe anti-rotation mechanisms, thereby helping to stabilize the entirerow of staples in tissue.

FIG. 18 illustrates a plurality of staples 1042 a, 1042 b, 1042 c, eachsimilar to the staple 1042 of FIG. 17, having been deployed such that apointed tip of a staple is captured as it rotates by an anti-rotationmechanism of the one of the staples having been deployed immediatelyprior thereto. In other words, a pointed tip 1046 b of the staple 1042 bdeployed second has been captured by an anti-rotation mechanism 1044 aof the staple 1042 a deployed first, and a pointed tip 1046 c of thestaple 1042 c deployed third has been captured by an anti-rotationmechanism 1044 b of the staple 1042 b deployed second. As shown in thisillustrated embodiment, a pointed tip 1046 a of the first staple 1042 acan not be coupled to an anti-rotation mechanism, and an anti-rotationmechanism of a last one of the deployed staples 1042 c can not becoupled to another staple. Only three staples 1042 a, 1042 b, 1042 c areshown in this illustrated embodiment, but nay number of staples can beso interconnected using anti-rotation mechanisms.

FIG. 19 illustrates another embodiment of a staple 1054 that includes ananti-rotation mechanism 1056 in the form of a coupling elementconfigured to engage an adjacently deployed staple. The staple 1054 inthis illustrated embodiment is generally configured and used like thestaple 1042 of FIG. 17 except that the staple 1054 includes a secondanti-rotation mechanism 1058. The second anti-rotation mechanism 1058 inthis illustrated embodiment a pointed tip 1060 of the staple 1056 havinga barb similar to the barb 1008 of FIG. 9. The second anti-rotationmechanism 1058 in the form of a barb can be configured to help hold thestaple 1054 in tissue and can be configured to help prevent the pointedtip 1060 from de-coupling from an adjacent staple's anti-rotationmechanism, e.g., from moving out of a hole of a ring or loop onceadvanced therein. FIG. 19 also shows an adjacent staple 1054 a(partially illustrated), which is generally configured and used similarto the staple 1054, with its pointed tip 1060 a and second anti-rotationmechanism 1058 a engaged by the anti-rotation mechanism 1056 of thestaple 1054.

In some embodiments, an orientation of a fastener relative to anorientation of one or more fasteners deployed adjacent thereto can beconfigured to help prevent counter rotation. In an exemplary embodiment,fasteners in one longitudinal row can all face in a first direction,e.g., proximally, and fasteners in a longitudinal row adjacent theretocan all face in an opposite direction, e.g., distally. In this way,forces exerted on tissue in which the fasteners facing oppositedirections are deployed can help hold the fasteners in the tissue.

FIG. 20 illustrates one embodiment in which a cartridge 1062 has staples1066 in adjacent longitudinal rows facing in opposite directions. Thestaples 1066 are shown deployed out of the cartridge 1062 for ease ofexplanation. The cartridge 1062 in this illustrated embodiment hasfirst, second, third, and fourth longitudinal rows 1064 a, 1064 b, 1064c, 1064 d rows of staples 1066. The staples 1066 in the first and fourthrows 1064 a, 1064 d can face a first direction, e.g., a distaldirection, when deployed, and the staples 1066 in the second and thirdrows 1064 b, 1064 c can face a second, opposite direction, e.g., aproximal direction, when deployed. In this way, when the staples 1062are in tissue, the adjacent first and second rows 1064 a, 1064 b ofstaples 1066 can face opposite directions, and the adjacent third andfourth rows 1064 c, 1064 d of staples 1066 can face opposite directions.A cutting element (not shown) can extend through a longitudinal slot1072 in the cartridge 1062 and cut tissue between the second and thirdrows 1064 b, 1064 c as discussed herein such that the second and thirdrows 1064 b, 1064 c having staples 1066 facing the same directiongenerally will not affect counter rotation.

As discussed herein, the staples 1066 can be deployed from the cartridge1062 by rotating out of openings 1068 formed in the cartridge'stissue-engaging surface 1070. Typically, all staples in a cartridge aredeployed as a sled moves longitudinally through the cartridge, e.g., asthe sled translates distally. However, the staples 1066 facing inopposite directions can be deployed in two passes of a sled through thecartridge 1062, one pass in which the sled translates distally to deploythe staples 1066 facing in one direction and another pass in which thesled translates proximally to deploy the staples facing the oppositedirection.

FIG. 21, FIG. 22, FIG. 23, and FIG. 24 illustrate one embodiment ofdeploying the staples 1066 that face in opposite directions using afirst sled 1074, a drive beam 1076 (also referred to herein as a “driverod” and an “I-beam”), and a second sled 1078, which are also shown inFIG. 25, FIG. 26, FIG. 27, and FIG. 28. Although this illustratedembodiment shows deployment of the staples 1066 disposed in thecartridge 1062, other staples disposed in other cartridges in facingopposite direction can be similarly deployed. The relative positions ofthe first sled, drive beam 1076, and second sled 1078 in FIG. 25, FIG.26, FIG. 27, and FIG. 28 correspond respectively to their positions inFIG. 21, FIG. 22, FIG. 23, and FIG. 24. The first sled 1074 can begenerally configured and used similar to the previously described sled1120. The first sled 1074 can include a cutting element 1080, whichincludes a knife in this illustrated embodiment. The cutting element1080 can be configured to pivot between a stowed position in which thecutting element's blade 1082 is generally obscured, as shown in FIG. 22,FIG. 23, FIG. 24, FIG. 26, FIG. 27, and FIG. 28, and an upright positionin which the cutting element 1080 extends through the slot 1072 suchthat the blade 1082 can cut tissue, as shown in FIG. 21 and FIG. 25.

As shown in FIG. 21 and FIG. 25, the second sled 1078 can be parked inan initial position near a distal end of the cartridge 1062. The drivebeam 1076 can be advanced distally, e.g., by manipulating a handle of asurgical device including the cartridge 1062 seated in an end effectorthereof, so as to cause the cutting element 1080 to move from the stowedposition to the upright position and so as to push the first sled 1074distally. The drive bean 1076 can include a guide member 1076 aconfigured to slide within a corresponding guide track (not shown)formed in the cartridge 1062, which can help the drive beam 1076translate straight and smoothly within the cartridge 1062. The distalmovement of the first sled 1074 can cause the second and third rows 1064b, 1064 c of staples 1066 to be deployed.

After deploying the staples 1066 in the second and third rows 1064 b,1064 c, the distally advancing first sled 1074 can advance distallybeyond the parked second sled 1078, as shown in FIG. 22 and FIG. 26, andthe drive rod 1076 can engage the parked second sled 1078, as shown inFIG. 23 and FIG. 27. The drive rod 1076 can engage the second sled 1078in a variety of ways. As in this illustrated embodiment, the drive rod1076 can include a protrusion 1076 b extending therefrom and configuredto engage a corresponding opening 1078 b formed in the second sled 1078.The first sled 1076 being advanced to its distal-most position relativeto the cartridge 1062 can cause a spring 1084, shown in FIG. 27, to bereleased. The spring 1084 can be coupled to the second sled 1078 and canbe biased upward such that release of the spring 1084 can cause thesecond sled 1078 to move upward, thereby allowing the protrusion 1076 bto engage the opening 1078 as shown in FIG. 23 and FIG. 27. The driverod 1076 can be advanced proximally, e.g., by manipulating the handle ofthe surgical device, so as to cause the second sled 1078 engaged withthe drive rod 1076 to move from the parked position and be advancedproximally with the drive rod 1076 due to the engagement of theprotrusion 1076 b and the opening 1078 b. As shown in FIG. 25 and FIG.28, the proximal movement of the second sled 1078 can cause the firstand fourth rows 1064 a, 1064 d of staples 1066 to be deployed. The firstsled 1074 can be parked near the distal end of the cartridge 1062 duringthe drive beam's and second sled's proximal movement, as also shown inFIG. 24 and FIG. 28. In this illustrated embodiment, the tissue is thuscut before all of the staples 1066 have been deployed since the tissueis cut by the cutting element 1080 during firing of the staples 1066 inthe second and third rows 1064 b, 1064 c and prior to firing of any ofthe staples in the first and fourth rows 1064 a, 1064 d.

Two-pass deployment of the staples 1066 in which a first portion of thestaples 1066 are deployed in one pass, e.g., a distal pass of the drivebeam 1076, and a second, remaining portion of the staples 1066 aredeployed in a second pass, e.g., a proximal pass of the drive beam 1076,can reduce a force needed to fire the staples 1066. A first force can berequired to deploy the staples 1066 in the first pass, and a secondforce can be required to deploy the staples 1066 in the second pass. Inthis way, instead of requiring a sum of the first and second forces todeploy all of the staples 1066, two smaller forces can be applied todeploy all of the staples. These reduced forces for firing can makefiring of staples much easier in devices having relative smalldiameters, such as those used in minimally invasive surgical procedures.For example, it can be difficult to generate a force required to deploystaples from an end effector of a 5 mm device, so effectively dividingthe force required in half by having two passes can make the deviceeasier to use and/or more effective in deploying staples properly.

In another embodiment of deploying staples from a cartridge in whichsome of the staples are disposed therein facing one direction and aremainder of the staples are disposed therein facing another, oppositedirection, a sled can be configured to advance distally through thecartridge so as to cause deployment of all of the staples. In otherwords, the sled's distal movement can be configured to cause deploymentof staples facing in opposed directions. Such a sled can include sidesthat extend upward and downward on left and right sides thereof so as toallow movement of the sled in one direction to cause deployment ofstaples facing in opposite directions.

In some embodiments, a surgical device such as the above-mentionedsurgical device 1100 can be configured to facilitate ejection offasteners from a cartridge that has the fasteners disposed therein. Ingeneral, the device can include at least one separation featureconfigured to facilitate complete removal of one or more fasteners fromwithin the cartridge. The fasteners can thus each be more likely to bedeployed into and remain within the tissue after a firing operationejecting the fasteners into the tissue, thereby facilitating completesealing of the tissue with the fasteners and/or facilitating healing ofthe tissue. The at least one separation feature can be configured tofacilitate complete ejection of the one or more fasteners after the oneor more fasteners have been deformed by an anvil, which cansignificantly reduce a force required to fire the one or more fastenersfrom the cartridge. In other words, a force to fire can be reduced asfastener forming and fastener disconnection can be timed separately withthe fastener being deformed prior to the fastener being fullydisconnected from the cartridge. In an exemplary embodiment, the devicecan be configured to facilitate disconnection of fasteners from acarrier to which the fasteners are frangibly attached. In general, thedevice can include a separation feature in the form of a shearingelement configured to facilitate separation of the fasteners from thecarrier when the fasteners are deployed from a cartridge that has thefasteners and the carrier disposed therein. The shearing element can bedisposed between a sled of the device and a drive beam of the device,which can facilitate complete ejection of the one or more fastenersafter the one or more fasteners have been urged toward the anvil by thesled.

The surgical device can be configured to facilitate ejection offasteners from a cartridge in a variety of ways. In the embodimentsdescribed below, staples are used as examples of fasteners, but as willbe appreciated by a person skilled in the art, other types of fastenerscan be similarly configured and used. In exemplary embodiments, thefasteners can be D-shaped fasteners such as the above-mentioned staples1116.

FIG. 29 and FIG. 30 illustrate one embodiment of a separation feature2002 configured to facilitate ejection of fasteners (not shown) from acartridge (not shown) that has the fasteners disposed therein andconnected to a carrier (not shown). As in this illustrated embodiment,the separation feature 2002 can include a shearing element configured toshear one or more of the fasteners from a carrier (not shown) to whichthe one or more fasteners are frangibly attached. The shearing element2002 can be coupled to a sled 2004 configured to urge the fasteners outof the cartridge, as discussed herein. The shearing element 2002 can bea discrete element from the sled 2004, as shown in FIG. 29, or theshearing element and the sled can be integrally formed. When theshearing element 2002 is independent from the sled 2004 as in thisillustrated embodiment, the sled 2004 and the shearing element 2002 caninclude corresponding mating features 2002 a, 2004 a configured tosecurely couple the sled 2004 and the shearing element 2002 together.

The shearing element 2002 can have a variety of sizes, shapes, andconfigurations. As in this illustrated embodiment, the shearing element2002 can include a plurality of shearing wedges 2006 each configured toshear at least one fastener from the carrier. In an exemplaryembodiment, a number of the shearing wedges 2006 can equal a number ofthe sled's wedges 2008 such that each of the fasteners deployed by a oneof the wedges 2008 can be sheared by an associated one of the shearingwedges 2006. The shearing wedges 2006 can generally extend upright andbe oriented at angles corresponding to the sled's wedges 2006. In anexemplary embodiment, the shearing wedges 2006 can be taller than thesled's wedges 2008, e.g., extend thereabove when the shearing element2002 and the sled 2004 are coupled together as shown in FIG. 30. Thisgreater upward reach of the shearing wedges 2006 can help ensure thatthe shearing wedges 2006 contact the fasteners so as to shear thefasteners. The shearing wedges 2006 may in some embodiments have enoughupward reach that they can slide against and/or otherwise contact thecartridge when translating therethrough, which may damage the cartridge.However, releasable and replaceable cartridges are typically used onlyonce, e.g., to once eject fasteners disposed therein, such that damagingthe cartridge does not affect effective use of the cartridge.

The shearing wedges 2006 can be sharp, e.g., have sharpened edges, whichcan help break deployed fasteners off the carrier. The shearing wedges2006 can be sharp and/or can extend upward of the sled's wedges 2008.

As shown in FIG. 29 and FIG. 30, the shearing element 2002 can bepositioned on a proximal side of the sled 2004. The shearing element2002 can thus be positioned proximal to the wedges 2008 of the sled2004. The sled 2004 includes four wedges 2008 in this illustratedembodiment, but as mentioned above, a sled can include any number ofwedges. In an exemplary embodiment, at least the wedges 2006 of theshearing element 2002 can be positioned entirely proximal to the wedges2008 of the sled 2004, as in this illustrated embodiment, which can helpensure that the fasteners have been pushed upward as fully as possibleby the wedges 2008 prior to the shearing element 2002 shearing thefasteners from the carrier. The shearing element 2002 can be positionedproximal to a cutting element 2010 of the sled 2004, which in thisillustrated embodiment includes a knife similar to the above-mentionedcutting element 1134. In an exemplary embodiment, at least the wedges2006 of the shearing element 2002 can be positioned entirely proximal tothe cutting element 2010, as in this illustrated embodiment, which canallow tissue to be cut and fasteners to be deployed into the tissuebefore the shearing element 2003 facilitates complete detachment of thefasteners from the carrier.

The shearing element 2002 can be disposed within a cartridge. In thisway, when the cartridge is configured to be releasably and replaceablycoupled to an end effector, the shearing element 2002 can also be socoupled.

A drive beam 2000 can be configured to advance the sled 2004 distallythrough the cartridge, as discussed herein. Thus, the drive beam 2000can also be configured to advance the shearing element 2002 distallythrough the cartridge when the drive beam 2000 advances the sled 2004therethrough.

FIG. 31 illustrates an alternate embodiment of a sled 2004′ that can beconfigured and used similar to the sled 2004 of FIG. 29 and FIG. 30.Each wedge 2008′ of the sled 2004′ of FIG. 3 includes a protrusion 2005extending laterally therefrom. A wedge's protrusion 2005 can beconfigured to crimp a fastener (not shown) pushed by that wedge 2008′,which can help ensure that the fastener is fully crimped, e.g., fullyclosed, before the shearing element 2002 shears the fastener from thecarrier.

As in the embodiments of FIG. 29, FIG. 30, and FIG. 31, the sled 2004and the shearing element 2002 can be configured to remain in a distalportion of the cartridge after the I-beam 2000 has advanced the sled2004 and the shearing element 2002 distally through the cartridge. Inother words, proximal retraction of the I-beam 2000 through thecartridge after firing of the fasteners does not proximally retract thesled 2004 or the shearing element 2002. The shearing element 2002 thusperforms all shearing during distal movement of the shearing element2002 through the cartridge. In some other embodiments, a sled and ashearing element can be configured to be proximally retracted after anI-beam has advanced the sled and the shearing element distally through acartridge. The shearing elements in these embodiments can perform allshearing during proximal movement of the shearing element through thecartridge. The fasteners can all be ejected from the cartridge duringthe distal movement of the sled and the cartridge such that all shearingby the shearing element can be performed after all of the fasteners havebeen deployed from the cartridge.

FIG. 32 illustrates an alternate embodiment of a shearing element 2002′that can be configured and used similar to the shearing element 2002 ofFIG. 29 and FIG. 30 except that in this illustrated embodiment, theshearing element 2002′ is coupled to an I-beam 2000′ instead of to asled 2001. The shearing element 2002′ can thus be included as anintegral part of a surgical device, as opposed to being part of acartridge removably and replaceably attachable to a surgical device.FIG. 33 illustrates the shearing element 2002′ disposed within acartridge (not shown) seated in a bottom jaw 2003 and including aplurality of fasteners 2007 a, 2007 b, 2007 c frangibly attached to acarrier 2009. Two of the fasteners 2007 a, 2007 b are shown frangiblyattached to the carrier 2009. A third one of the fasteners 2007 c isshown detached from the carrier 2009, e.g., having been sheared thereofby the shearing element 2002′.

FIG. 34 and FIG. 35 illustrate one embodiment of a sled 2012 and ashearing element 2014 coupled to the sled 2012 that are configured to beproximally retracted in a proximal direction 2028 after an I-beam 2016has advanced the sled 2012 and the shearing element 2014 distallythrough a bottom jaw 2018 in a distal direction 2030. The jaw 2018 inthis illustrated embodiment is part of an end effector 2020 that alsoincludes an anvil 2022, and has a cartridge (not shown) releasably andreplaceably seated in the bottom jaw 2018.

The shearing element 2014 can have a variety of sizes, shapes, andconfigurations. As in this illustrated embodiment, the shearing element2014 can include a movable bar. The shearing element 2014 can be movablebetween a first position, shown in FIG. 34, in which the sled 2012 neststhe shearing element 2014, and a second position, shown in FIG. 35, inwhich the shearing element 2014 extends upwardly above the sled 2012.The shearing element 2014 in the first position can be configured to notshear any fasteners 2026, and the shearing element 2014 in the secondposition can be configured to shear fasteners 2026. The shearing element2014 can be configured to move from the first position to the secondposition, e.g., pivot about a pivot joint 2034, in response to a drivebar 2032 coupled to the drive beam 2016 being moved proximally so as toproximally retract the drive beam 2016. The shearing element 2014 canthus be configured to automatically move from the first position to thesecond position.

The cartridge can include an attachment bar 2024 configured to removablycouple to the drive bar 2032. In response to the cartridge being seatedin the bottom jaw 2018, the attachment bar 2024 can clip onto the drivebar 2032, e.g., by a protrusion at a proximal end of the attachment bar2024 engaging a corresponding protrusion at a distal end of the drivebar 2032. Thus, when the drive bar 2032 moves distally or proximally,the attachment bar 2024 can also move distally or proximally. Theattachment bar 2024 can be attached to the sled 2012 such that themovement of the attachment bar 2024 can also cause movement of the sled2012 and the shearing element 2014 attached thereto. FIG. 34 shows thedrive bar 2032 coupled to the attachment bar 2024 and advancing distallyin the distal direction 2030 so as to advance the sled 2012 distallywith a cutting element 2036 of the sled 2012 pivoted to an uprightposition and with the shearing element 2014 in the first position. FIG.35 shows the drive bar 2032 coupled to the attachment bar 2024 andadvancing proximally in the proximal direction 2028 so as to advance thesled 2012 proximally with a cutting element 2036 of the sled 2012 in theupright position and with the shearing element 2014 in the secondposition. Moving the drive bar 2032 proximally can cause the shearingelement 2014 to pivot from the first position to the second positionsince the pivot joint 2034 about which the shearing element 2014 can beconfigured to pivot can be an attachment point between the shearingelement 2014 and the attachment bar 2024.

In some embodiments, a separation feature can be formed on a fastener.FIG. 36 and FIG. 37 illustrate another embodiment of a separationfeature 2040 formed on a fastener 2042 and configured to facilitateejection of the fastener 2042 from a cartridge (not shown) that has thefastener 2042 disposed therein and connected to a carrier strip 2044. Asin this illustrated embodiment, the separation feature 2040 can includea bump formed on the fastener 2042 and configured to engage a sled 2046.

The bump 2040 can have a variety of sizes, shapes, and configurations.The bump 2040 can be formed on a substantially straight leg 2048 of thefastener 2042 and can be formed on an outward-facing surface thereof,thereby allowing the sled 2046 to engage the bump 2040 when contactingand deploying the fastener 2040. The bump 2040 can be configured to biasthe fastener 2042 in an upward direction 2050, e.g., toward an anvilcoupled to a jaw having the cartridge seated therein. This bias canincrease stress on the fastener 2042 at a joint 2052 where the fastener2042 is frangibly connected to the carrier 2044, thereby allowing thefastener 2042 to more reliably disconnect from the carrier strip 2044. Asize of the bump 2040 can be tuned to the stress needed to disconnectthe fastener 2042 from the carrier 2044. FIG. 36 and FIG. 37 show one ofthe fasteners 2042 disconnected from the carrier 2044 such that thejoint where the fastener 2042 was frangibly connected to the carrier2044 is now a broken joint 2054.

In some embodiments, a sled can include a separation feature in the formof a bump similar to the above-mentioned bump 2040. The sled can includethe bump in alternative to or in addition to a fastener including a bumpsuch as the above-mentioned bump 2040. The sled and the fastener eachincluding a bump can exert more stress on a joint where the fastenerfrangibly connects to a carrier than when only one of the sled and thefastener includes a bump, which can allow the fastener to more reliablydisconnect from the carrier.

FIG. 38 illustrates another embodiment of a separation feature 2056formed on a fastener and configured to facilitate ejection of thefastener 2058 from a cartridge (not shown) that has the fastener 2058disposed therein and connected to a carrier strip 2060. Similar to theabove-mentioned separation feature 2040, the separation feature 2056 caninclude a bump formed on the fastener 2056. However, in this illustratedembodiment, the separation feature 2056 is formed at a distal end of thefastener 2058, with the fastener's distal end being with reference tothe fastener's position as deployed from a sled 2062 translatingdistally through the cartridge. The bump 2056 being formed at thefastener's distal end can allow the bump 2056 to engage the fastener2058 being deployed immediately after the fastener 2056 having its bump2056 positioned distally with reference to the fastener's position asdeployed from the sled 2062. More particularly, a pointed tip 2064 ofthe fastener's curved leg 2066 can be configured to push against thebump 2056 of the fastener 2056 longitudinally aligned therewith anddeployed immediately prior to the fastener 2056 whose tip 2064 pushesthe bump 2056, as shown by an arrow 2068. This force applied to the bump2056 can facilitate detachment from the carrier 2060 of the fastener2956 whose bump 2056 is being pushed, as shown by an arrow 2070.

In some embodiments, a separation feature can be formed on a cartridge,e.g., the above-mentioned cartridge 1112. In general, the separationfeature being formed on the cartridge can be configured to providecounter resistance to a fastener, e.g., the above-mentioned fastener1116, after the fastener has been pushed upward by a sled, e.g., thesled , and formed. The separation feature can thus help ensure that thefastener disconnects from a carrier to which the fastener is frangiblyattached within the cartridge pre-deployment.

FIG. 39, FIG. 40, and FIG. 41 illustrate an embodiment of a cartridge2072 that includes a plurality of separation features 2074 that can eachbe configured to facilitate separation of one of a plurality offasteners 2076 disposed within the cartridge 2072 and frangibly attachedto a carrier 2078 disposed within the cartridge 2072. The separationfeature 2074 can have a variety of sizes, shapes, and configurations. Asin this illustrated embodiment, the separation feature 2074 can includea wall extending upward-downward, e.g., in a direction substantiallyperpendicular to a direction 2080 in which a sled 2082 can be configuredto translate to eject the fasteners 2074 from the cartridge 2072 throughopenings 2084 formed in the cartridge 2072. For ease of illustration,the sled 2082 is only partially shown in FIG. 40. The wall isrectangular shaped in this illustrated embodiment, but the wall can haveother shapes, e.g., square, semi-circular, triangular, etc. In otherembodiments, instead of a wall, the separation feature 2074 can includea protrusion, such as a bump, extending from a surface of the cartridge2072.

Each of the separation features 2074 can be positioned adjacent to aconnection point 2086 where its associated fastener 2076 is frangiblyattached to the carrier 2078. As in this illustrated embodiment, theseparation feature 2074 can be adjacent to and positioned above theconnection point 2086. When the sled 2082 translates in the direction2080, e.g., distally, as shown in FIG. 40, the sled 2082 can cause thefastener 2076 to rotate out of the opening 2084 to be deployed, asdiscussed herein. As shown in FIG. 41, the separation feature 2074 canbe configured to exert a force 2088, e.g., a downward directed force,that opposes a force 2090, e.g., an upward directed force, exerted bythe sled 2082. The separation feature's force 2088 can resist the sled'sforce 2090, thereby facilitating breakage of the fastener 2074 from thecarrier 2078 at the connection point 2086.

FIG. 42, FIG. 43, FIG. 44, FIG. 45, and FIG. 46 illustrate anotherembodiment of a cartridge 2092 that includes a separation feature 2094that can be configured to facilitate separation of one of a plurality offasteners 2096 disposed within the cartridge 2092. In this illustratedembodiment, the fasteners 2096 can be disposed within the cartridge 2092as discrete elements not attached to a carrier, e.g., each of thefasteners 2096 can be disposed in its own pocket formed in the cartridge2092 below a tissue-engaging surface 2100 of the cartridge 2092.Fasteners being discrete element unattached to a carrier can betterguide fasteners during fastener forming and/or can help prevent thefastener from having any jagged edges where the fastener detaches from acarrier. Such jagged edges can be sharp and/or otherwise irritating totissue in which the fastener is secured. The pocket can have a shapecorresponding to a shape of the fastener, which can facilitaterotational forming of the fastener and/or facilitate easy separation ofthe fastener from the cartridge.

The separation feature 2094 in this illustrated embodiment includes aretainer plate. The retainer plate 2094 can have a variety of sizes,shapes, and configurations. The retainer plate 2098 can define thetissue-engaging surface 2100 and can have a plurality of openings 2102formed therein through which the fasteners 2096 can be ejected from thecartridge 2092. Each of the openings 2102 can include a first slotextending in a proximal-distal direction and a second slot extendinglaterally and substantially perpendicular to the first slot such thatthe opening 2102 can have a “T” shape or a cross shape. The openings2102 each have a cross shape in this illustrated embodiment. Thefasteners 2096 can each include a retention pin 2104 configured to movethrough the opening 2102, e.g., the second slot thereof, when alignedtherewith. The retention pin 2104 can be formed adjacent a proximal endof the fastener 2096, as in this illustrated embodiment, with thefastener's proximal end being with reference to the fastener's positionas deployed from a sled 2106 translating in a distal direction 2110through a bottom jaw 2108 having the cartridge 2092 seated therein. Theopenings 2102 can thus be configured as key holes through which thefasteners 2096 can be configured to pass so as to be fired out of thecartridge 2092.

The retainer plate 2094 can be configured to move relative to thefasteners 2096 and to the bottom jaw 2108 to facilitate ejection of thefasteners 2096 from the cartridge 2092. This movement can allow thefasteners 2096 to pass through the openings 2102 by aligning theretention pins 2104 with the opening's second slot. By way of example, aright-most one of the fasteners 2096 in FIG. 42 is shown in a stowedposition within the cartridge 2092 below the tissue-engaging surface2100 prior to the sled's engagement therewith. The middle fastener 2096in FIG. 42 shows the fastener 2096 moved from the right-most fastener'sposition, the fastener 2096 having been engaged by the sled 2106 asshown in FIG. 43 to move the fastener 2096 through the opening 2102,e.g., through the first slot thereof, by rotation 2098 thereof. Theretention pin 2104 is not aligned with the opening's second slot and islocated under the tissue-engaging surface 2100. The left-most fastener2096 in FIG. 42 shows the fastener 2096 released from the cartridge 2092after the retention plate 2094 has moved relative to the fasteners 2096and the bottom jaw 2092.

The retention plate 2094 can be configured to move relative to thefasteners 2096 and the bottom jaw 2092 in response to an end effector2112 that includes the bottom jaw 2092 and an upper jaw 2114 moving froma closed position, shown in FIG. 43 and FIG. 44, to an open position,shown in FIG. 45 and FIG. 46. As shown in FIG. 43, FIG. 44, FIG. 45, andFIG. 46, the retention plate 2094 can be configured to move distally inresponse to the opening of the end effector 2112, thereby causing theopenings 2102 to align with the fastener 2096 such that the retentionpins 2104 can pass therethrough, e.g., pass through the opening's secondslots. The fasteners 2096 can thus be configured to all be released fromthe cartridge 2092 substantially simultaneously in response to themovement of the retention plate 2094. As shown in FIG. 43, FIG. 44, FIG.45, and FIG. 46 illustrate that the retention plate 2094 can move adistance 2116 in the distal direction 2110 in response to the endeffector 2112 opening.

FIG. 47, FIG. 48, FIG. 49, FIG. 50, FIG. 51, and FIG. 52 illustrateanother embodiment of a cartridge 2118 that includes a separationfeature 2120 that can be configured to facilitate separation of one of aplurality of fasteners 2122 disposed within the cartridge 2118. In thisillustrated embodiment, the fasteners 2122 can be disposed within thecartridge 2118 as discrete elements not attached to a carrier.

The separation feature 2120 in this illustrated embodiment includes atleast one tab. In general, each of the at least one tabs 2120 can beconfigured to retain one of the fasteners 2122 within the cartridge 2118until a sled 2124 engages the fastener 2122 and urges the fastener 2122upward, e.g., toward an anvil (not shown). The at least one tab 2120 canhave a variety of sizes, shapes, and configurations. As in thisillustrated embodiment, the at least one tab 2120 can include opposedtabs, one proximal tab and one distal tab. The cartridge 2118 caninclude a plurality of openings 2126 formed in a tissue-engaging surface2128 thereof, with one of the separation features 2120 being adjacent toeach one of the openings 2126, e.g., with each of the openings 2126having associated therewith one proximal tab and one distal tab. Similarto the openings 2102 of FIG. 42, each of the openings 2126 can include afirst slot extending in a proximal-distal direction and a second slotextending laterally and substantially perpendicular to the first slotsuch that the opening 2126 can have a “T” shape or a cross shape. Theseparation feature 2120 can be located at the second slot, as in thisillustrated embodiment.

Each of the fasteners 2122 can include a retention pin 2130. Theretention pin 2130 and the at least one tab 2120 can be configured tocooperate to retain the fastener 2122 within the cartridge 2118pre-deployment, as shown in FIG. 47, FIG. 50, and FIG. 52 (the left-mostfastener 2122). In response to the sled 2124 engaging the fastener 2122,e.g., by translating distally through the cartridge 2118, the sled 2124can cause the fastener 2122 to rotate, as shown in FIG. 48, FIG. 51, andFIG. 52 (the middle fastener 2122). The sled's continued distaladvancement can, as shown in FIG. 49 and FIG. 52 (the right-mostfastener 2122), cause the fastener 2122 to be pushed over the at leastone tab 2120 and thereby be released from the cartridge 2118. The sled2124 can thus be configured to provide enough of an upward force 2132,shown in FIG. 49, to push the fastener's retention pin 2130 past the atleast one tab 2120. The fasteners 2122 can thus be released sequentiallyfrom the cartridge 2118 as the sled 2124 engages and pushes each of thefasteners 2122.

FIG. 53 illustrates an alternate embodiment of a separation feature2120′ in the form of at least one tab that can be configured and usedsimilar to the at least one tab 2120 of FIG. 47. In this illustratedembodiment, the at least one tab 2120′ includes first and second tabspositioned on lateral sides of an opening 2126′ formed in atissue-engaging surface 2128′ of a cartridge. Similar to the openings2126 of FIG. 47, each of the openings 2126′ can include a first slotextending in a proximal-distal direction and a second slot extendinglaterally and substantially perpendicular to the first slot such thatthe opening 2126′ can have a “T” shape or a cross shape, and theseparation feature 2120′ can be extend into the second slot.

FIG. 54 illustrates another alternate embodiment of a separation feature2120″ in the form of at least one tab that can be configured and usedsimilar to the at least one tab 2120 of FIG. 47. In this illustratedembodiment, the at least one tab 2120″ includes first and second tabspositioned on a proximal side of an opening 2126″ formed in atissue-engaging surface 2128″ of a cartridge. Similar to the openings2126 of FIG. 47, each of the openings 2126″ can include a first slotextending in a proximal-distal direction and a second slot extendinglaterally and substantially perpendicular to the first slot such thatthe opening 2126″ can have a “T” shape or a cross shape, and theseparation feature 2120″ can extend into the second slot.

FIG. 55, FIG. 56, FIG. 57, FIG. 58, and FIG. 59 illustrate anotherembodiment of a cartridge 2134 that includes a separation feature 2136that can be configured to facilitate separation of one of a plurality offasteners 2138 disposed within the cartridge 2134. In general, each oneof the separation features 2136 can be configured to cooperate with oneof the fasteners 2138 to cause the fastener 2138 to move laterallyrelative to the separation feature 2136, e.g., relative to the cartridge2134, to facilitate firing of the fastener 2138 through one of aplurality of openings 2140 formed in the cartridge 2134. In thisillustrated embodiment, the fasteners 2138 can be disposed within thecartridge 2134 as discrete elements not attached to a carrier.

The separation feature 2136 in this illustrated embodiment includes apost configured to releasably engage the fastener 2138. The post 2136can have a variety of sizes, shapes, and configurations. As in thisillustrated embodiment, the post 2136 can be located adjacent theopening 2140 and can extend laterally from an internal surface of thecartridge 2134 below a tissue-engaging surface 2142 of the cartridge2134. The post 2136 can be configured to be seated in a hole 2144 formedin its associated fastener 2136 when the fastener 2136 is disposedwithin the cartridge 2134, as shown in FIG. 57. The fastener 2136 caninclude a cam surface 2146 adjacent the hole 2144 that can be configuredto slidably engage the post 2136 when the fastener 2138 is being rotatedout of the opening 2140 in response to an urging force from a sled (notshown) translating through the cartridge 2134, as shown in FIG. 58. Alongitudinal axis of the post 2136 can define an axis of the fastener'srotation. The cam surface's engagement with the post 2136 can cause thefastener 2138 to move laterally relative to the post 2136 and aremainder of the cartridge 2134. In other words, the cam surface 2146can cause the fastener 2138 to be cammed laterally. The lateral movementof the fastener 2136 can cause the post 2136 to move out of the hole2144, thereby allowing the fastener 2136 to exit the opening 2140, asshown in FIG. 59. The fasteners 2138 can thus be released sequentiallyfrom the cartridge 2134 as the sled engages and pushes each of thefasteners 2138.

FIG. 60, FIG. 61, FIG. 62, FIG. 63, FIG. 64, and FIG. 65 illustrateanother embodiment of a cartridge 2148 that includes a separationfeature 2150 that can be configured to facilitate separation of one of aplurality of fasteners 2152 disposed within the cartridge 2148. In thisillustrated embodiment, the fasteners 2152 can be disposed within thecartridge 2148 as discrete elements not attached to a carrier. Ingeneral, each one of the separation features 2150 can be configured tocooperate with a retention feature 2156 of one of the fasteners 2152 tocause the fastener 2152 to exit the cartridge 2148 through one of aplurality of openings 2158 formed in the cartridge 2148.

The separation feature 2150 in this illustrated embodiment includes acam surface 2154 configured to engage the corresponding retentionfeature 2156, e.g., a cam, of the fastener 2152. The cam surface 2154and the cam 2156 can have a variety of sizes, shapes, andconfigurations. As in this illustrated embodiment, the cam surface 2154can have a curved shape, and the cam 2156 can have a correspondingcurved shape configured to slidably engage the cam surface 2154, asshown in FIG. 63 and FIG. 64. In addition to its curved surface, the cam2156 can have a substantially flat surface. The cam's substantially flatsurface can be configured to engage an inner surface of the cartridge2148 when the fastener 2152 is disposed within its pocket formed in thecartridge 2148, as shown in FIG. 62. The engagement of the cam'ssubstantially flat surface and the cartridge's inner surface canfacilitate retention of the fastener 2152 within the cartridge 2148until a sled (not shown) translates through the cartridge 2148 to rotatethe fastener 2152 and thereby urge the fastener 2152 out of the opening2158. In this illustrated embodiment, the cam 2156 includes two pinseach having a half moon shape and each extending laterally from thefastener 2152 adjacent a proximal end of the fastener 2152, but the cam2156 can, as mentioned above, have other shapes and configurations. Forexample, a fastener can include only one pin extending laterally fromone side of the fastener, can include only one pin extending through thefastener to extend laterally from opposed sides thereof, etc.

As shown in FIG. 62, the fastener 2152 can be disposed within thecartridge 2148 in a first position with the cam 2156, e.g., thesubstantially flat surface thereof, engaging the inner surface of thecartridge 2148. When the sled translates in a distal direction 2160through the cartridge 2148 and engages the fastener 2152, the fastener2152 can be pushed in the distal direction 2160 such that the cam 2156disengages from the inner surface of the cartridge 2156 and contacts thecam surface 2150, as shown in FIG. 63. As shown in FIG. 64, continueddistal movement of the sled can cause the cam 2156, e.g., the curvedsurface thereof, to slidably engage the cartridge's cam surface 2150,thereby causing the fastener 2152 to rotate. The fastener 2152 can thenrotate out of the opening 2158, as shown in FIG. 65.

In some embodiments, a surgical device such as the above-mentionedsurgical device 1100 can be configured to facilitate guidance offasteners during deployment of the fasteners into tissue. In general,the surgical device can include one or more guidance features configuredto facilitate guidance of the fasteners during ejection of the fastenersfrom the cartridge. The one or more guidance features can be configuredto reduce lateral movement of the fasteners during deployment thereof,thereby allowing the fasteners to be more accurately positioned withinthe tissue relative to one another and relative to the tissue. Byhelping to guide the fastener into the tissue, the fastener can be lesslikely to skew laterally during deployment into the tissue due toresistance of the tissue and/or tissue flow can be reduced duringfastener deployment. The fasteners can thus be effectively positionedrelative to one another and to the tissue to facilitate proper healingand/or sealing of the tissue. This can be particularly beneficial inrelatively thick tissue because the tissue can provide relatively highresistance to the fastener being deployed therein. In an exemplaryembodiment, each of the one or more guidance features can be configuredto support a fastener on three sides thereof during deployment of thefastener, thereby helping to minimize lateral movement of the fastenerduring the deployment. The one or more guidance features can be formedon the cartridge, e.g., formed on a surface thereof or formed on a sleddisposed in the cartridge, and/or can be formed on a jaw that seats thecartridge.

A surgical device can be configured to guide fasteners during deploymentthereof in a variety of ways. In the embodiments described below,staples are used as examples of fasteners, but as will be appreciated bya person skilled in the art, other types of fasteners can be similarlyconfigured and used.

In some embodiments, a cartridge having a plurality of fastenersdisposed therein can include one or more guidance features, alsoreferred to herein as “guide members,” configured to guide the fastenersduring firing of the fasteners from the cartridge. As discussed herein,the cartridge can be configured to be removably and replaceably seatedin an end effector of a surgical device. FIG. 66 and FIG. 67 illustrateone embodiment of a cartridge 3000 that includes a plurality offasteners 3008 disposed therein, a sled 3004 including a movable cuttingelement 3006, and one or more guide members 3002 configured to guide thefasteners 3008 during firing of the fasteners 3008 from the cartridge3000. In this illustrated embodiment, the fasteners 3008 include staplessimilar to the above-mentioned staples 1116, but as also mentionedabove, other types of staples or fasteners can be used. As in thisillustrated embodiment, the one or more guide members 3002 can each beformed on and protrude upward from a tissue-engaging surface 3010 of thecartridge 3000, e.g., in a direction toward an anvil (not shown) of thesurgical device. The guidance provided by the guide members 3002 canthus be provided after the fasteners 3008 have at least partially exitedtheir respective fastener-receiving recesses 3012 so as to pass abovethe tissue-engaging surface 3010. The guide members 3002 protrude upwardfrom the tissue-engaging surface 3010 can allow the guide members 3002to be located in a gap of space between the tissue-engaging surface 3010and a tissue-engaging surface (not shown) of the anvil, which can helpgrip tissue positioned within the gap of space. Movement or flow of thetissue within the gap of space can thus be reduced, which can allow thetissue to be more effectively fastened.

The guide members 3002 can have a variety of sizes, shapes, andconfigurations. Each of the guide members 3002 can have an inner arcuatesurface, as in this illustrated embodiment. The inner arcuate surfacecan be configured to guide a second leg 3014 of the staple 3008 along anarcuate path as the staple 3008 is being deployed into a tissue (notshown). As discussed herein, the staple 3008 can also include asubstantially straight first leg (not shown) connected to the curvedsecond leg 3014. The inner arcuate surface of each of the guide members3002 can be shaped to mimic a curvature of the fastener's second leg3014, thereby helping to maximize an amount of movement support for thefastener 3008 during deployment thereof. As in this illustratedembodiment, the guide members 3002 can each be U-shaped with opposedsidewalls and a curved intermediate portion connecting the sidewalls. Asshown in FIG. 67, the sidewalls can be configured to support andmaintain alignment of the fastener during deployment. Being opposed, thesidewalls can help prevent lateral movement of the fastener 3008 duringdeployment. As shown in FIG. 67, the opposed sidewalls and the curvedintermediate portion can be configured to contact three sides of thefastener 3008 as the fastener is guided by the guide member 3002 duringdeployment, thereby helping to prevent lateral movement of the fastener3008 due to the sidewalls and helping to prevent distal movement of thefastener 3008 due to the intermediate portion.

Each of the guide members 3002 can be formed adjacent to and on a distalside of their respective fastener-receiving recesses 3012, as shown inthis illustrated embodiment. In this way, when the fasteners 3008 aredriven out of the cartridge 3000 in response to distal translation ofthe sled 3004 through the cartridge, the guide members 3002 can beconfigured to guide their respective fasteners' second legs 3014 as thesecond legs 3014 rotate out of the cartridge 3002 to lead the fasteners3008 out of the cartridge 3002.

In the embodiment of FIG. 66, the one or more guide members 3002 arelocated above the tissue-engaging surface 3010. In other embodiments, acartridge can include one or more guide members located below atissue-engaging surface of the cartridge. Being located below thetissue-engaging surface can help prevent the guide members from snaggingon and/or otherwise interfering with tissue engaged by the cartridgeand/or from affecting an amount of space between facing tissueengagement surfaces of an end effector within which tissue can bepositioned and clamped. In some embodiments, a cartridge can include oneor more guide members that are located both above and below atissue-engaging surface thereof.

FIG. 68, FIG. 69, and FIG. 70 illustrate another embodiment of acartridge 3016 that includes a plurality of fasteners 3018 disposedtherein, a sled (not shown), and one or more guide members 3020configured to guide the fasteners 3018 during firing of the fasteners3018 from the cartridge 3016. The fasteners 3018, the cartridge 3016,and the guide members 3020 can be generally configured and used similarto the fasteners 3008, the cartridge 3000, and the guide members 3002,respectively, of FIG. 66 and FIG. 67. In this illustrated embodiment,however, the one or more guide members 3020 are each located below atissue-engaging surface 3022 of the cartridge 3016 and are each formedadjacent to and on a distal side of a staple-receiving recess 3024.Similar to the guide members 3002 of FIG. 66, the guide members 3020 caneach include opposed sidewalls (best shown in FIG. 69) and an innerarcuate surface shaped to mimic a curvature of the fastener's second leg3026, thereby allowing the guide members 3020 to support theirassociated fasteners 3008 on three sides thereof during fastenerdeployment.

As discussed above, one or more guide members can be formed on a surfaceof a cartridge. In other embodiments, as mentioned above, a cartridgecan include one or more guide members formed on a sled disposed withinthe cartridge and configured to translate therethrough to drivefasteners out of the cartridge. The sled can thus be configured tosupport and maintain alignment of fasteners being deployed in responseto the sled's translation relative thereto. The sled including guidancefeatures can help allow existing cartridges to be only slightlymodified, or not modified at all, in order to include guidance featuresbecause the sleds including guidance features can be incorporated intothe existing cartridges.

FIG. 71 illustrates one embodiment of a sled 3028 that includes one ormore guide members 3030 a, 3030 b, 3030 c, 3030 d, a cutting element3032 configured to move between first and second positions, one or morewedges 3034 a, 3034 b, 3034 c, 3034 d configured to drive fasteners fromthe cartridge, and a base 3036. The sled 3028 can be used with any ofthe cartridges discussed herein. Each of the wedges 3034 a, 3034 b, 3034c, 3034 d can have one of the guide members 3030 a, 3030 b, 3030 c, 3030d associated therewith. Thus, a number of the wedges 3034 a, 3034 b,3034 c, 3034 d can equal a number of the guide members 3030 a, 3030 b,3030 c, 3030 d. As in this illustrated embodiment, as also shown in FIG.72 and FIG. 73, the guide members 3030 a, 3030 b, 3030 c, 3030 d caninclude lateral guide walls of the wedges 3034 a, 3034 b, 3034 c, 3034d. The guide walls can be configured to provide lateral support tofasteners being deployed by the sled 3028 via engagement with the wedges3034 a, 3034 b, 3034 c, 3034 d. Without the guide walls, the fastenermay only receive guidance from a pivot point about which the fastenerrotates during deployment thereof. This pivot point, however, is weakwhen the fastener is configured to break off from the pivot point duringfastening, such as with the fasteners 1116 in the above-mentioned device1100.

As shown in FIG. 72 and FIG. 73, when the sled 3028 engages fasteners3036 a, 3036 b, 3036 c, 3036 d so as to push and deploy the fasteners3036 a, 3036 b, 3036 c, 3036 d, the guide walls defined by the guidemembers 3030 a, 3030 b, 3030 c, 3030 d can engage the fasteners 3036 a,3036 b, 3036 c, 3036 d and provide directional movement guidance suchthat lateral movement of the fasteners 3036 a, 3036 b, 3036 c, 3036 dcan be minimized In this illustrated embodiment, the fasteners 3036 a,3036 b, 3036 c, 3036 d include staples similar to the above-mentionedstaples 1116, but as also mentioned above, other types of staples orfasteners can be used.

As discussed above, one or more guide members can be formed on a surfaceof a cartridge and/or can be formed on a sled. In other embodiments, asmentioned above, a jaw that seats a cartridge, e.g., a jaw configured toreleasably and replaceably receive a cartridge, can include one or moreguide members. The jaw, and hence an end effector that includes the jaw,can thus be configured to support and maintain alignment of fastenersbeing deployed therefrom. The jaw including guidance features can helpallow existing cartridges to be used with a device including guidancefeatures without the cartridges having to be modified.

FIG. 74 and FIG. 75 illustrate an embodiment of a jaw 3038 that includesone or more guide members. The jaw 3038 is shown in FIG. 74 as part ofan end effector 3040 that includes the jaw 3038 and a second jaw 3042,e.g., an anvil. The one or more guide members can be in the form ofopposed substantially vertical sidewalls 3044 a, 3044 b configured toengage side of a cartridge received within the jaw 3038, andsubstantially flat bottom surfaces 3046 a, 3046 b on either side of acentral longitudinal channel 3048 configured to slidably receive a drivebeam, also referred to herein as an “I-beam,” through the jaw 3038. Aperson skilled in the art will appreciate that the vertical sidewalls3044 a, 3044 b may not be precisely vertical, e.g., due to manufacturingtolerances, but nevertheless be considered to be substantially vertical.Similarly, a person skilled in the art will appreciate that the flatbottom surfaces 3046 a, 3046 b may not be precisely flat, e.g., due tomanufacturing tolerances, but nevertheless be considered to besubstantially flat. The substantially flat bottom surfaces 3046 a, 3046b can help provide a better seat for the cartridge within the jaw 3038for vertically created tissue loads. The substantially verticalsidewalls 3044 a, 3044 b can be configured to help minimize cartridgespread, e.g., movement of the cartridge within the jaw 3038 in which itis seated, during fastener deployment, e.g., due to the I-beam slot,which can help provide more robust fastener formation. Cartridge spreadcan become more pronounced the thicker the tissue being grasped andfastened by the end effector 3040. The substantially vertical sidewalls3044 a, 3044 b can help resist the vertical forces created duringmovement of the I-beam for fastener deployment and can provide aboutthree times more resistance than sidewalls that are not substantiallyvertical.

FIG. 76 and FIG. 77 illustrate another embodiment of a jaw 3050 thatincludes one or more guide members. The jaw 3050 is shown in FIG. 77 aspart of an end effector 3052 that includes the jaw 3052 and a second jaw3054, e.g., an anvil. The jaw 3050 can be generally configured and usedsimilar to the jaw 3038 of FIG. 74 and FIG. 75. The jaw 3050 in thisillustrated embodiment includes one or more guide members in the form ofopposed substantially vertical sidewalls 3056 a, 3056 b configured toengage side of a cartridge received within the jaw 3050, and asubstantially flat bottom surface 3058 along which an drive beam 3060can be configured to translate through the jaw 3050. FIG. 74 illustratesan embodiment of spreading forces 3062 a, 3062 b that the substantiallyvertical sidewalls 3056 a, 3056 b can be configured to counter duringfastener deployment.

In some embodiments, a surgical device such as the above-mentionedsurgical device 1100 can be configured to facilitate closing of an endeffector and clamping of tissue by the end effector. In general, thesurgical device can be configured to increase a moment arm of the endeffector, thereby increasing a closure force of the end effector. Theend effector can thus be more securely closed and can more securelygrasp tissue. The tissue can therefore be less likely to shift positiononce grasped by the end effector, which can facilitate grasping oftarget tissue by the end effector and/or can allow fasteners to be firedmore accurately into the tissue from the end effector. The increasedmoment arm can provide significantly higher end effector closureefficacy in response to an actuation force, e.g., manipulation of thedevice's handle to effect end effector closure, than in response to thesame actuation force applied. The smaller a diameter of an elongateshaft of the device, the lower the load that an end effector at a distalend of the shaft can tolerate without breaking and/or other reducedeffectiveness. By increasing a moment arm at the end effector's proximalend, the shaft can have a relatively small diameter, e.g., diametersappropriate for use of the device in a minimally invasive surgicalprocedure, while having an end effector that is relatively easy to closeand while providing relatively strong clamping of tissue engaged by theend effector. In an exemplary embodiment, a surgical device can includea closure mechanism configured to provide an increased moment arm at thedevice's end effector, such as at a proximal end thereof.

In some embodiments, a surgical device can include a closure mechanismin the form of a lobe cam. FIG. 78 illustrates one embodiment of asurgical device that includes a closure mechanism 4000 in the form of alobe cam. In general, the lobe cam 4000 can be configured to improveclosing of the device's end effector 4012 and clamping of tissue by theend effector 4012. The end effector 4012 can be coupled to a distal endof the device's elongate shaft 4008, and can include an upper jaw 4004and a bottom jaw 4002. The lobe cam 4000 can be configured to be pulledin a proximal direction 4016 to improve the moment arm.

The lobe cam 4000 can have a variety of sizes, shapes, andconfigurations. As in this illustrated embodiment, the closure mechanism4000 can be positioned adjacent a proximal end 4010 of the upper jaw4004, as in this illustrated embodiment. The lobe cam 4000 can bepivotally coupled to the bottom jaw 4002 at a pivot point 4014 aboutwhich the lobe cam 4000 can be configured to move. The device caninclude an actuator 4006 configured to be actuated via manipulation ofthe device's handle (not shown) so as to move the closure mechanism4000, as discussed further below. The actuator 4006 can extend along theshaft 4008, e.g., through an inner lumen thereof, and can be coupled tothe closure mechanism 4000. The actuator 4006 includes a cable in thisillustrated embodiment, but the actuator 4006 can have other sizes,shapes, and configurations.

The lobe cam 4000 can be configured to move between first and secondpositions. The lobe cam 4000 can be in a first position when the endeffector 4012 is in the open position, as shown in FIG. 78, and can bein the second position when the end effector 4012 is in the closedposition, as shown in FIG. 80. FIG. 79 shows the lobe cam 4000 in anintermediate position between the first and second positions when theend effector 4012 is moving from the open position to the closedposition. The lobe cam 4000 can be biased to the first position, e.g.,by the actuator 4006 applying a biasing force thereto. In otherembodiments, the lobe cam 4000 can be biased to the second position,e.g., by the actuator 4006 applying a biasing force thereto.

When the end effector 4012 begins to move from the open position of FIG.78, the actuator 4006 can be pulled in the proximal direction 4016, asshown in FIG. 79. The pulling of the actuator 4006 can cause the lobecam 4000 to rotate, as shown by an arrow 4018 in FIG. 79, therebycausing the lobe cam 4000 to push against the upper jaw 4004 so as toapply a force to the proximal end 4010 thereof. This force can increaseclosure of the end effector 4012. As the end effector 4012 continuesclosing, the lobe cam 4000 can continue applying the force to the upperjaw's proximal end 4010. When the end effector 4012 is in the closedposition, as shown in FIG. 80, the lobe cam 4000 can continue applyingthe force to the upper jaw 4004, which can increase a clamping force ofthe end effector 4012 by forcing the upper jaw's proximal end in anupward direction 4020, thereby forcing the upper jaw's distal end 4022in a downward direction 4024 toward the bottom jaw 4002. An end reactionforce when the end effector 4012 is in the closed position can be in adirection 4028 that is substantially perpendicular to a longitudinalaxis of the shaft 4008 along which the actuator 4006 extends and alongwhich the actuator 4006 applies force to the lobe cam 4000. The endeffector 4012 can thus be effectively closed and effectively clamptissue engaged since substantially all of the pulling force in theproximal direction 4016 is applied to the end reaction force in thesubstantially perpendicular direction 4028. When the end effector 4012moves from the closed position to the open position, the lobe cam 4000can move from the second position back to the first position.

FIG. 81 and FIG. 82 illustrate an alternate embodiment of a closuremechanism 4030 in the form of a lobe cam that can be configured and usedsimilar to the closure mechanism 4000 of FIG. 78. In this illustratedembodiment, the lobe cam 4030 can be biased to a second position, shownin FIG. 82, corresponding to an end effector 4036 being in an openposition, e.g., first and second jaws 4042, 4040 jaws thereof beingopen. A spring 4038 coupled to the lobe cam 4030 can provide a biasingforce that biases the lobe cam 4030 to the second position. The surgicaldevice can include a support member 4044 configured to couple to thespring 4038. An actuator 4032, e.g., a cable, can be configured to bepulled in a proximal direction 4034 to counteract the bias and move thelobe cam 4030 from the second position to a first position, shown inFIG. 81, corresponding to the end effector 4036 being in a closedposition.

In some embodiments, a surgical device can include a closure mechanismin the form of a wedge. FIG. 83, FIG. 84, and FIG. 85 illustrate oneembodiment of a surgical device that includes a closure mechanism 4046in the form of a wedge. In general, the wedge 4046 can be configured toimprove closing of the device's end effector 4048 and clamping of tissueby the end effector 4048. The end effector 4048 can be coupled to adistal end of the device's elongate shaft 4050, and can include an upperjaw 4052 and a bottom jaw 4054. The wedge 4046 can be configured to bepushed in a distal direction 4056 to improve the moment arm.

The wedge 4046 can have a variety of sizes, shapes, and configurations.As in this illustrated embodiment, the wedge 4046 can be configured tobe slidably movable within an inner lumen of the shaft 4050 and can beconfigured to engage a proximal end 5058 of the upper jaw 4052, as shownin FIG. 84 and FIG. 85. The wedge 4046 can be configured to be soslidably movable by, e.g., manipulating a handle (not shown) of thedevice. When the end effector 4048 is in an open position, as shown inFIG. 83, the wedge 4046 can be configured to not apply a force to theupper jaw 4052, such as by not being engaged therewith. When the endeffector 4048 is moving from the open portion to a closed position, thewedge 4046 can be advanced in the distal direction 4056 such that a camsurface 4046 a of the wedge 4046, e.g., a sloped distal end of the wedge4046, engages the upper jaw 4052 and applies a force to the proximal end4058 thereof. By being sloped at the distal end thereof, the wedge 4046can have a relatively low profile at the distal end, which can help thewedge 4046 fit into the relatively small space available at the endeffector 4048 while providing the mechanical advantage of an increasedmoment arm. As in the illustrated embodiment, the wedge 4046 can beadvanced under the upper jaw's proximal end 4058 so as to push upwardthereon. As the end effector 4048 continues closing, the wedge 4046 cancontinue applying the force to the upper jaw's proximal end 4058. Whenthe end effector 4048 is in the closed position, as shown in FIG. 85,and similar to the embodiment of FIG. 80, the wedge 4046 can continueapplying the force to the upper jaw 4052, which can increase a clampingforce of the end effector 4048 by forcing the upper jaw's proximal endin an upward direction 4060, thereby forcing the upper jaw's distal end4062 in a downward direction 4064 toward the bottom jaw 4054. The upperand bottom jaws 4052, 4054 can be more rigid mechanically in the closedposition due to the presence of the wedge 4046. An end reaction forcewhen the end effector 4048 is in the closed position can be in adirection 4064 that is substantially perpendicular to a longitudinalaxis of the shaft 4050 along which the wedge 4046 extends. When the endeffector 4048 moves from the closed position to the open position, thewedge 4046 can move from the second position back to the first position.

In some embodiments, a surgical device can include a closure mechanismin the form of a two-bar linkage. FIG. 86, FIG. 87, FIG. 88, and FIG. 89illustrate one embodiment of a surgical device that includes a closuremechanism 4066 in the form of a two-bar linkage. In general, the two-barlinkage 4066 can be configured to improve closing of the device's endeffector 4068 and clamping of tissue by the end effector 4068. The endeffector 4068 can be coupled to a distal end of the device's elongateshaft 4070, and can include an upper jaw 4072 and a bottom jaw 4074. Thetwo-bar linkage 4066 can be configured to be pulled in a proximaldirection 4076 to improve the moment arm.

The two-bar linkage 4066 can have a variety of sizes, shapes, andconfigurations. As in this illustrated embodiment, the two-bar linkage4066 can include a first or proximal bar 4078 and a second or distal bar4080. The first bar 4078 can be coupled to an actuation shaft 4086slidably disposed along the shaft 4070, e.g., slidably disposed withinan inner lumen of the shaft 4070, and actuatable via manipulation of thedevice's handle (not shown). In some embodiments, the first bar 4078 canbe directed manipulated via the handle. The second bar 4080 can becoupled to the first bar 4078, such as at a pivot point 4084, and can beconfigured to be movable relative thereto, e.g., by pivoting at thepivot point 4084. The second bar 4080 can also be operatively connectedto the upper jaw 4072. The second bar 4080 can have a pin 4076 formedthereon. The pin 4076 can be slidably disposed within a slot 4082 formedin the bottom jaw 4074. The pin 4076 can define a pivot point aboutwhich the end effector 4068 opens and closes.

The actuation shaft 4086 and the first bar 4078 coupled thereto can beslidably movable in a distal direction 4088, as shown in FIG. 86 andFIG. 88, and in the proximal direction 4076, as shown in FIG. 87 andFIG. 89. In response to the actuation shaft 4086 and the first bar 4078moving in the distal direction 4088, the second bar 4080 can move in adownward direction 4090 such that the pin 4076 slides in the downwarddirection 4090 within the slot 4086, thereby urging the end effector4068 toward the open position. In response to the actuation shaft 4086and the first bar 4078 moving in the proximal direction 4076, the secondbar 4080 can move in an upward direction 4092 such that the pin 4076slides in the upward direction 4092 within the slot 4086, thereby urgingthe end effector 4068 toward the closed position. The upper and bottomjaws 4072, 4074 can be more rigid mechanically in the closed positiondue to the presence of the two-bar linkage 4066. An end reaction forcewhen the end effector 4068 is in the closed position can be in thedownward direction 4090 that is substantially perpendicular to alongitudinal axis of the shaft 4070 along which the actuation shaft 4086and the first bar 4078 extend.

In some embodiments, a surgical device can include a closure mechanismin the form of a rotating element. FIG. 90 and FIG. 91 illustrate oneembodiment of a surgical device that includes a closure mechanism 4094in the form of a rotating element. In general, the rotating element 4094can be configured to improve closing of the device's end effector 4096and clamping of tissue by the end effector 4096. The end effector 4096can be coupled to a distal end of the device's elongate shaft 4098, andcan include an upper jaw 4100 and a bottom jaw 4102. A cartridge 4103can be seated in the bottom jaw 4102, as shown in this illustratedembodiment. The rotating element 4094 can be configured to rotate toimprove the moment arm.

The rotating element 4094 can have a variety of sizes, shapes, andconfigurations. As in this illustrated embodiment, the rotating element4094 can include a wheel attached to the bottom jaw 4102 at a fixedpoint 4104 and attached to the upper jaw 4100 via a link bar 4106. Thelink bar 4106 can have one end 4106 a attached to the wheel 4094 and anopposite end 4106 b attached to the upper jaw 4100. The wheel 4094 canbe coupled to an actuator 4108 configured to cause rotation of the wheel4094 at the fixed point 4014. The actuator 4108 can be configured to beactuated via the device's handle (not shown) and can extend along theshaft 4098, as in tis illustrated embodiment. The actuator 4108 can havea variety of sizes, shapes, and configurations. As in this illustratedembodiment, the actuator 4108 can include a cable.

The device can include a bias element 4110, e.g., a spring, configuredto bias the end effector 4096 to an open position, shown in FIG. 90. Asshown in FIG. 91, in response to the actuator 4108 being moved in afirst direction 4112, e.g., counterclockwise, the wheel 4094 can beconfigured to rotate in the first direction 4112 about the fixed point4104, thereby causing the ends 4106 a, 4106 b of the link 4106 to moveand the upper jaw 4100 to move toward the bottom jaw 4102. The rotationof the wheel 4094 in the first direction 4112 can thus move the endeffector 4096 to the closed position. The movement of the actuator 4108in the first direction 4112 can overcome the bias force provided by thespring 4110 to allow the end effector 4096 to close. Similarly, as shownin FIG. 90, in response to the actuator 4108 being moved in a seconddirection 4114, e.g., clockwise, that is opposite to the first direction4112, the wheel 4094 can be configured to rotate in the second direction4114 about the fixed point 4104, thereby causing the ends 4106 a, 4106 bof the link 4106 to move and the upper jaw 4100 to move away from bottomjaw 4102. The rotation of the wheel 4094 in the second direction 4114can thus move the end effector 4096 to the open position. The bias forceprovided by the spring 4110 can facilitate the opening of the endeffector 4096.

FIG. 92, FIG. 93, FIG. 94, and FIG. 95 illustrate another embodiment ofa surgical device that includes a closure mechanism in the form of arotating element. In this illustrated embodiment, the rotating elementincludes a plurality of rotating elements 4116 a, 4116 b, e.g., rotatingwheels. The rotating wheels 4116 a, 4116 b can generally be configuredand used similar to the above-mentioned wheel 4094 and can be coupled toand actuated by first and second actuators 4130 a, 4130 b, respectively.By including a second wheel 4116 b, motions of the wheels 4116 a, 4116 bcan be timed to effect various types of end effector closures. Closureof the device's end effector 4122 can thus be selectively controlled ata user's discretion. In general, the wheels 4116 a, 4116 b can allow theend effector 4122 to be selectively closed in parallel fashion, closeddistal end first, and closed proximal end first.

By including a second wheel 4116 b, motions of the wheels 4116 a, 4116 bcan be timed so that they can cause the end effector 4122 to which thewheels 4116 a, 4116 b are attached to close in a parallel fashion, asshown in FIG. 92 and FIG. 93. In other words, an upper jaw 4118 of theend effector 4112 can move in a downward direction 4124 toward a bottomjaw 4120 of the end effector 4122, as opposed to the rotational“alligator” type closing of the end effector 4096 coupled to a singlewheel 4094.

Including a second wheel 4116 b can allow the motions of the wheels 4116a, 4116 b to be timed so that a distal end (not shown) of the endeffector 4122 begins closing first, as indicated by an arrow 4124 inFIG. 94, e.g., before movement of the end effector's proximal end.Closing the distal end first can aid with tissue capture between thejaws 4118, 4120. The motions of the wheels 4116 a, 4116 b can becontrolled to first allow distal closure of the end effector 4122 bystarting motion of the distal one of the wheels 4116 a, as shown by anarrow 4126, before starting motion of the proximal one of the wheels4116 b.

Including a second wheel 4116 b can allow the motions of the wheels 4116a, 4116 b to be timed so that the end effector 4112 closes in an“alligator” type fashion by beginning to close the proximal end of theend effector 4122 before beginning to close the distal end of the endeffector 4122, as shown in FIG. 95. The motions of the wheels 4116 a,4116 b can be controlled to first allow proximal closure of the endeffector 4122 by starting motion of the proximal one of the wheels 4116b, as shown by an arrow 4132, before starting motion of the distal oneof the wheels 4116 a.

In some embodiments, a surgical device can include a closure mechanismin the form of a closure tube. FIG. 96, FIG. 97, and FIG. 98 illustrateone embodiment of a surgical device that includes a closure mechanism4134 in the form of a closure tube. In general, the closure tube 4134can be configured to rotate to provide increased moment arm to thedevice's end effector 4136.

The closure tube 4134 can have a variety of sizes, shapes, andconfigurations, and can be configured to move longitudinally in avariety of ways. As in the illustrated embodiment, the closure tube 4134can include an internal thread 4138 matable with a corresponding thread4140 on a stationary one of the end effector's upper and bottom jaws4142, 4144, e.g., the bottom jaw 4144. The closure tube 4134 can beconfigured to rotate about a longitudinal axis thereof so as tothreadably move the end effector 4136 proximally or distally, dependingon a direction of the closure tube's rotation. The internal threads4138, 4140 can have a consistent size, e.g., have consistent leadstherealong, which can allow the end effector 4136 to move longitudinallyat a constant rate. Alternatively, as in the illustrated embodiment, theinternal threads 4138, 4140 can have a variable size, e.g., have varyingleads therealong, which can allow the end effector 4136 to movelongitudinally at a variable rate. In this way, the end effector 4136can be closed at a first rate, e.g., by having larger leads or coarserproximal threads 4138, 4140, and then close at a second, slower rate,e.g., by having smaller leads or finer distal threads 4138, 4140, so asto provide a higher force when the closure tube 4134 is rotating at thesecond, slower rate so as to provide a greater mechanical advantage.

In response to the closure tube's rotation, the end effector 4136 can beproximally advanced into the closure tube 4136 when closing the endeffector 4136, and the end effector 4136 can be distally advanced out ofthe closure tube 4136 when opening the end effector 4136. A pivot point4148 about which the end effector 4136 opens and closes, e.g., aboutwhich the upper jaw 4142 moves relative to the bottom jaw 4144, can beconfigured to move in and out of the closure tube 4134. In general, themore proximally located the pivot point 4148, the more force that can beapplied to the end effector 4136 to effect its closure and clamping.

The closure tube 4134 can be configured to rotate any number of degreesto fully move the end effector 4136 between the open and closedpositions. In an exemplary embodiment, the closure tube 4134 can rotateat least 360°, e.g., one full 360° rotation, three full 360° rotations,five full 360° rotations, six full 360° rotations, etc.

The closure tube 4136 can be configured to be moved longitudinally in avariety of ways. For example, the device can include an actuator (notshown), e.g., a rotatable knob, a movable lever, a rack/pinionmechanism, etc., manipulatable at a handle (not shown) of the devicethat can be configured to be manipulated to effect movement of theclosure tube 4136. For another example, the closure tube 4136 can beconfigured to rotate in response to an actuator, e.g., a firing trigger,etc., configured to be manipulated to fire fasteners from the device.For yet another example, the rotation of the closure tube 4136 can beconfigured to be motor-powered. For another example, the closure tube4136 can be configured to be manually rotated by hand.

The end effector 4136 can include a protruding lobe 4146 extendingradially outward therefrom. The protruding lobe 4146 can be configuredto increase a force exerted by the closure tube 4134 on the end effector4136 when the closure tube 4134 engages the protruding lobe 4146, e.g.,when the protruding lobe 4146 is at least partially disposed within thetube 4134. FIG. 96 and FIG. 97 show the protruding lobe 4146 outside theclosure tube 4134, and FIG. 98 shows the protruding lobe 4146 partiallydisposed within the closure tube 4134.

In some embodiments, a surgical device can include a closure mechanismin the form of a truss. FIG. 99, FIG. 100, FIG. 101, FIG. 102, and FIG.103 illustrate one embodiment of a surgical device that includes aclosure mechanism 4150 in the form of a truss. In general, the truss4150 can be configured to improve closing of the device's end effector4152 and clamping of tissue by the end effector 4152. The smaller an endeffector 4152, e.g., the smaller the end effector's diameter, the lessbending stiffness the end effector 4152 has, and the more likely the endeffector 4152 is to bend and reduce the closure and clampingeffectiveness of the end effector 4152. The truss 4150 can be configuredto provide increased being stiffness and, thus, make the end effector4152 less likely to bend, even if the end effector 4152 is small.

The truss 4150 can have a variety of sizes, shapes, and configurations.The truss 4150 can be configured to increase a size of the end effector4152, e.g., a size of one of the upper and bottom jaws 4154, 4156thereof, which can increase structural strength the end effector 4152,e.g., by increasing a rigidity of the end effector 4152. This increasedstructural strength of the end effector 4152 can allow the end effector4152 to more forcefully close and clamp when the truss 4150 is deployed,e.g., is expanded. In an exemplary embodiment, the truss 4150 can beconfigured to move between a collapsed position and an expandedposition. In the collapsed position, shown in FIG. 99 and FIG. 102 (withthe end effector 4152 in solid lines), the end effector 4152 can have afirst size and a first strength. As in this illustrated embodiment, thetruss 4150 in the collapsed position can be configured to be disposedwithin one of the jaws 4154, 4156, e.g., the upper jaw 4154. In theexpanded position, shown in FIG. 100, FIG. 101, FIG. 102 (with the endeffector 4152 in dotted lines), and FIG. 103, the end effector 4152 canhave a second size that is greater than the first size and a secondstrength that is greater than the first strength. As in this illustratedembodiment, the truss 4150 in the expanded position can be configured toextend outward from the one of the jaws 4154, 4156 in which the truss4150 is disposed when in the collapsed position. The truss 4150 beingmovable between the collapsed and expanded configurations can allow thedevice to be advanced into a patient's body with a first, smaller size,e.g., with the truss 4150 in the collapsed position, which canfacilitate use of the device in a minimally invasive surgical procedure.

The truss 4150 can be configured to move between the expanded andcollapsed positions in a variety of ways. The device can include anactuator 4158, e.g., a rod, a cable, etc., configured to be manipulatedat a handle (not shown) of the device to selectively collapse and expandthe truss 4150. In this illustrated embodiment, the actuator 4158includes a cable. In response to movement of the actuator 4158 in adistal direction 4160, as shown in FIG. 100 and FIG. 103, the truss 4150can be configured to move from the collapsed position to the expandedposition. In response to movement of the actuator 4158 in a proximaldirection 4162, as shown in FIG. 102, the truss 4150 can be configuredto move from the expanded position to the collapsed position. In otherembodiments, proximal movement of an actuator can cause a truss to movefrom a collapsed position to an expanded position, and distal movementof the actuator can cause the truss to move from the expanded positionto the collapsed position.

As in this illustrated embodiment, the truss 4150 can include aplurality of movable links connected together. The truss 4150 includeseight movable links in this illustrated embodiment, but a truss caninclude another number of movable links

The end effector 4152 can include a slot 4164 formed therein, as shownin FIG. 102 and FIG. 103, in which the truss 4150 can be configured toslide to facilitate movement between the collapsed and expandedpositions. The truss 4150 can include a pin 4166 configured to slidewithin the slot 4164, as shown in FIG. 103. As in this illustratedembodiment, a distal-most one of the movable links can include the pin4166. The slot 4164 and the pin 4166 can cooperate to facilitate asmooth, controlled transition of the truss 4150 between the collapsedand expanded positions.

In some embodiments, a surgical device can include a closure mechanismin the form of an external compression member. FIG. 104, FIG. 105, FIG.106, FIG. 107, and FIG. 108 illustrate one embodiment of a surgicaldevice that includes a closure mechanism 4168 in the form of an externalcompression member. In general, the external compression member 4168 canbe configured to improve closing of the device's end effector 4170 andclamping of tissue by the end effector 4170. The end effector 4170 caninclude an upper jaw 4172 and a bottom jaw 4174. The externalcompression member 4168 can be configured to translate along the endeffector 4170 externally thereto to apply a closing force thereto,thereby improving the moment arm. The external compression member 4168,being external to the end effector 4170, can be configured as anexoskeleton. Being located to the end effector 4170 can allow theexternal compression member 4168 to help prevent twisting and/orshifting of the end effector 4170 during firing of fasteners from theend effector 4170. By being located external to the end effector 4170,the external compression member 4168 can be positioned radially outwardfrom a longitudinal axis of the end effector 4170, which can allow theexternal compression member 4168 to provide support and closing force tothe end effector 4170, e.g., to the one of the jaws 4172 along whoseexternal surface the external compression member 4168 translates.

The device includes a single external compression member 4168 in thisillustrated embodiment, but in some embodiments, a device can include aplurality of external compression members. For example, a firstcompression member can be configured to translate along a first endeffector jaw, and a second compression member can be configured totranslate along a second end effector jaw.

The external compression member 4168 can have a variety of sizes,shapes, and configurations. In an exemplary embodiment, the externalcompression member 4168 can be formed on an I-beam 4176 configured totranslate along the end effector 4170, as discussed herein. The I-beam4176 can thus be configured translate along the end effector 4170 with aportion thereof, e.g., the external compression member 4168, translatingoutside the end effector 4170. The external compression member 4168 canthus be configured to be actuated in conjunction with actuation of theI-beam 4176, which can make the external compression member 4168 easyfor a user to actuate. The external compression member 4168 can beformed on an upper portion of the I-beam 4176, as in this illustratedembodiment, such that the external compression member 4168 can form a“roof” of the I-beam 4176.

The I-beam 4716 can include other features, as will be appreciated by aperson skilled in the art, such as a guide pin 4178 configured totranslate along the upper jaw 4172, e.g., in a channel formed therein,to facilitate closing of the end effector 4170, and such as a foot 4180configured to translate along the bottom jaw 4174, e.g., in alongitudinal slot formed therein, to facilitate smooth, controlledtranslation of the I-beam 4176 through the end effector 4170.

When the end effector 4170 is in an open position, as shown in FIG. 107,the external compression member 4168 can be located adjacent a proximalend of the end effector 4170. As shown in FIG. 108, as the end effector4170 moves from the open position to a closed position, the externalcompression member 4168 can translate distally along the end effector4168 so as to provide a compressive force thereto during firing offasteners disposed within the end effector 4170, as discussed herein.

In some embodiments, a surgical device can include a closure mechanismin the form of an internal end effector protrusion. FIG. 109 and FIG.110 illustrate one embodiment of a surgical device that includes aclosure mechanism 4182 in the form of an internal end effectorprotrusion. In general, the internal end effector protrusion 4182 can beconfigured to improve closing of the device's end effector 4184 andclamping of tissue by the end effector 4184. The end effector 4184 caninclude an upper jaw 4186 and a bottom jaw 4188. The internal endeffector protrusion 4182 can be configured to increase stiffness of theend effector 4184 to improve the moment arm.

The internal end effector protrusion 4182 can have a variety of sizes,shapes, and configurations. As in this illustrated embodiment, theinternal end effector protrusion 4182 can include one or more supportmembers located adjacent a proximal end of the end effector 4184. Bybeing located near the end effector's proximal end, the closuremechanism 4182 can be configured to provide increased strength to theeffector's proximal end, which can increase a moment of inertia of theend effector's proximal end, thereby increasing the moment arm. Theclosure mechanism 4182 can be formed on the upper jaw 4186, as in thisillustrated embodiment, and extend in a direction toward the bottom jaw4188.

The device in this illustrated embodiment includes two support members4182, but a device can include another number of lateral supportmembers. The two support members 4182 can be positioned on either sideof an I-beam 4190, as shown in FIG. 110, that can be configured totranslate through the end effector 4184 and advance a sled 4192therethrough, as discussed herein. The support members 4182 can thus beconfigured to help guide and support the I-beam 4190 and/or help preventbuckling of the I-beam 4190 in embodiments in which the I-beam 4190 isflexible.

In some embodiments, a surgical device such as the above-mentionedsurgical device 1100 can include at least one adjunct material to helpimprove surgical procedures performed using the surgical device. Ingeneral, an end effector of a surgical device can be configured todeliver one or more synthetic materials and/or biologic materials,collectively referred to herein as “adjunct materials,” to a surgicalsite during a surgical procedure to help improve the surgical procedure.The one or more adjunct materials can be disposed between and/or on oneor both of first and second jaws of the device, incorporated into acartridge disposed in the end effector and having a plurality offasteners therein, or otherwise placed in proximity to fastenersconfigured to be deployed from the end effector. When the fasteners aredeployed at a treatment site, the adjunct material(s) can remain at thetreatment site with the fasteners. In at least some instances, theadjunct material(s) can be configured to help seal holes formed by thefasteners as they are implanted into tissue, and/or the adjunctmaterial(s) can be configured to provide tissue reinforcement at thetreatment site. In at least some instances, the adjunct material(s) canbe configured to wick or absorb beneficial fluids, e.g., sealants,blood, glues, that further promote healing, and in at least someinstances, the adjunct material(s) can be configured to degrade to forma gel, e.g., a sealant, that further promotes healing. In at least someinstances, the adjunct material(s) can help reduce inflammation, promotecell growth, and otherwise improve healing.

The adjunct materials have any number of configurations and properties.Embodiments of adjunct materials and coupling adjunct materials to endeffectors are further described in U.S. application Ser. No. 14/300,954entitled “Adjunct Materials And Methods Of Using Same In SurgicalMethods For Tissue Sealing” filed Jun. 10, 2014, which is herebyincorporated by reference in its entirety.

In the embodiments described below, staples are used as examples offasteners, but as will be appreciated by a person skilled in the art,other types of fasteners can be similarly configured and used. Inexemplary embodiments of surgical devices including one or more adjunctmaterials, the fasteners can include “D” shaped staples such as theabove-mentioned staples 1116, and the fasteners can be frangiblyattached to a carrier.

In some embodiments, a surgical device can include at least one adjunctmaterial disposed on a tissue-engaging surface of a cartridge. Thecartridge can have a plurality of fasteners, e.g., “D” shaped fasteners,disposed therein and frangibly attached to a carrier also disposed inthe cartridge. The cartridge can be configured to be removably coupledto an end effector.

FIG. 111, FIG. 112, and FIG. 113 illustrate one embodiment of acartridge 5000 having at least one adjunct material 5002 coupledthereto. The at least one adjunct material 5002 in this illustratedembodiment includes a single adjunct material, but as mentioned herein,any number of adjunct materials can be used. Additionally, although theat least one adjunct material in this illustrated embodiment includes afoam, other types of adjunct materials can be used. In an exemplaryembodiment, the foam can be bioabsorbable.

As in this illustrated embodiment, the at least one adjunct material5002 can be coupled to the cartridge 5000 by being disposed on atissue-engaging surface 5008 thereof. The tissue-engaging surface 5008can have a plurality of openings 5010 formed therein through whichfasteners 5006 disposed in the cartridge 5000 can be ejected. The atleast one adjunct material 5002 can completely cover all of the openings5010 such that the fasteners 5006 must each pass into the at least oneadjunct material 5002 when ejected through the openings 5010 and into atissue 5004, as shown in FIG. 112 and FIG. 113. The at least one adjunctmaterial 5002 can cover the entire tissue-engaging surface 5008, as inthis illustrated embodiment, so as to extend across an entire length andwidth thereof. The at least one adjunct material 5002 can thus beassured of covering all of the openings 5010 so that all fasteners 5006can be ejected into the at least one adjunct material 5002 and then intotissue. In other embodiments, the at least one adjunct material 5002 canbe disposed over one or more discrete portions of the tissue-engagingsurface 5008 so as to not cover the entire length and width thereof,thereby requiring use of less adjunct material.

FIG. 114 shows the fasteners 5006 deployed in the tissue 5004 with theat least one adjunct material 5002 sandwiched between substantiallystraight first legs 5006 a of the fasteners 5006 and a lower surface ofthe tissue 5004. The at least one adjunct material 5002 can beconfigured, as also shown in FIG. 114, to compensate for a varyingthickness of the tissue 5004, e.g., for a first tissue thickness 5012that is less than a second tissue thickness 5014. The at least oneadjunct material 5002 can be compressible, thereby facilitating suchtissue thickness compensation.

FIG. 114 illustrates another embodiment of a cartridge 5016 having atleast one adjunct material 5018 coupled thereto. The at least oneadjunct material 5018 in this illustrated embodiment includes a singleadjunct material, but as mentioned herein, any number of adjunctmaterials can be used. The at least one adjunct material 5018 in thisillustrated embodiments includes a plurality of independent adjunctmaterials that can each be configured to span across at least twoopenings 5020 formed in a tissue-engaging surface 5022 of the cartridge5016. Each of the adjunct materials 5018 can thus be configured to haveat least two fasteners 5024, shown in FIG. 115 and FIG. 116, passtherethrough from within the cartridge 5016 when ejected through the atleast two openings 5020 underlying the adjunct material 5018. By havingat least two fasteners 5024 pass therethrough and secured thereto whenthe fasteners 5024 are secured in tissue, the adjunct material 5018 canhelp prevent any one of the fasteners 5024 from rotating and/orotherwise shifting in the tissue, as shown in FIG. 117, since the one ofthe fasteners 5024 is interconnected with at least one other fastener5024 via the adjunct material 5018. By having a single adjunct material5018 have a subset of a total number of fasteners 5024 secured intissue, the adjunct material 5018 can be configured to provide theadjunct material's benefits while allowing the fasteners 5024 to shiftas needed for, e.g., tissue thickness accommodations, tissue movementduring healing, etc.

As in this illustrated embodiment, each of the adjunct materials 5018can be configured to cover at least two longitudinally aligned ones ofthe openings 5020. Accordingly, at least two longitudinally alignedfasteners 5024 can be ejected through each of the independent adjunctmaterials 5018. Longitudinal alignment of interconnected fasteners 5024can further help prevent any one of the fasteners 5024 from rotatingand/or otherwise shifting in the tissue in which the fasteners 5024 aredeployed, since the “D” shaped fasteners 5024 would tend to rotate alongthe longitudinal axis of the adjunct material 5018.

FIG. 118 illustrates an alternate embodiment of an adjunct material5018′ that can be configured and used similar to the adjunct material5018 of FIG. 115. Instead of being configured to cover at least twolongitudinally aligned openings formed in a cartridge's tissue-engagingsurface and have at least two longitudinally aligned fasteners deployedtherethrough, the adjunct material 5018′ in this illustrated embodimentcan be configured to cover at least two laterally offset andlongitudinally offset openings (not shown) formed in a cartridge'stissue-engaging surface (not shown) and have at least two laterallyoffset and longitudinally offset fasteners 5024′ deployed therethrough.

FIG. 119, FIG. 120, FIG. 121, and FIG. 122 illustrate an alternateembodiment of an adjunct material 5018″ that can be configured and usedsimilar to the adjunct material 5018 of FIG. 118. Instead of beingconfigured to receive at least two fasteners facing in a same directionwhen deployed, such as the fasteners 5024′ of FIG. 118, the adjunctmaterial 5018″ can be configured to receive at least two fasteners 5024″facing in opposite directions when deployed from a cartridge 5016″. Eachpair of two fasteners 5024″ when deployed can effectively form a “B”shape, as shown in FIG. 120, FIG. 121, and FIG. 122, which can resistloads more effectively than the fasteners 5024″ when not deployed in the“B” shape.

In some embodiments, an adjunct material can include an anti-rotationfeature configured to help prevent rotation of a fastener deployedthrough the adjunct material when the fastener is secured in tissue andengaging the adjunct material. FIG. 123, FIG. 124, and FIG. 125illustrate one embodiment of an adjunct material 5026 including ananti-rotation feature 5028. In this illustrated embodiment, the adjunctmaterial 5026 includes a film, but as mentioned above, other types ofadjunct materials can be used. The film can have a thickness in a rangeof e.g., about 0.003 mm to 0.009 mm or about 0.006 mm to 0.009 mm.

The anti-rotation feature 5028 can have a variety of sizes, shapes, andconfigurations. The adjunct material 5026 can include a plurality ofopenings 5030 formed therein that can each be aligned with acorresponding one of a plurality of openings (not shown) formed in acartridge's tissue-engaging surface (not shown) through which fasteners5032, also shown in FIG. 126, can be deployed. Each one of the openingscan have one of the anti-rotation features 5028 extending laterallytherein. The anti-rotation feature 5028 in this illustrated embodimentincludes a tab having a rectangular shape, but the anti-rotation feature5028 can have other shapes, e.g., semi-circular, square, etc. Theanti-rotation feature 5028 can have a size and shape corresponding to aside and shape of a corresponding anti-rotation feature 5034 of thefastener 5032.

The fastener's anti-rotation feature 5034 can also have a variety ofsizes, shapes, and configurations. In an exemplary embodiment, thefastener's anti-rotation feature 5034 can be formed in an inner-facingsurface of a substantially straight first leg 5038 of the fastener 5032,which also includes a curved second leg 5036. The fastener 5032 caninclude an anti-rotation member 5040, e.g., a barb, etc., configured tohelp prevent the fastener's rotation in tissue when the fastener 5032 isdeployed therein. The anti-rotation member 5040 can define a sidewall ofthe anti-rotation feature 5034, as shown in FIG. 126. The adjunctmaterial's anti-rotation feature 5028 can be configured to be seated inthe fastener's anti-rotation feature 5034 when the fastener 5032 rotatesthrough the cartridge's opening and the adjunct material's opening 5030so as to be positioned within tissue, as shown in FIG. 124 and FIG. 125.The fastener's anti-rotation member 5040 and the adjunct material'santi-rotation feature 5028 seated in the fastener's anti-rotationfeature 5034 can each help prevent the fastener 5032 from rotatingwithin tissue in which the fastener 5032 is deployed.

In some embodiments, a surgical device such as the above-mentionedsurgical device 1100 can be configured to facilitate removable couplingof a cartridge to an end effector of a surgical device. In general, oneof the cartridge and the surgical device can include at least one matingelement, and the other of the cartridge and the surgical device caninclude at least one engagement feature configured to removably engagethe at least one mating element. The engagement of the at least onemating element and the at least one engagement feature can help ensurethat the cartridge is fully mated to the surgical device such that thesurgical device can properly fire fasteners disposed within thecartridge. Some embodiments of surgical devices can be configured toprevent fastener firing unless the cartridge is fully seated therein.The engagement of the at least one mating element and the at least oneengagement feature can be configured to provide a positive indicationthat the cartridge is fully seated in the end effector. The positiveindication can be visually and/or audibly detectable by a user seatingthe cartridge in the surgical device's end effector, thereby allowingthe user to verify proper seating of the cartridge. The visual detectionof the at least one mating element and the at least one engagementfeature's engagement can be from an outside of the device such that nofurther assembly or disassembly of the device is needed to perform thevisual detection and/or such that no special tools, e.g., a magnifier,are needed for the visual detection.

Some end effectors have particularly small diameters, such as thoseappropriate for use in a minimally invasive surgical procedure, suchthat cartridges removably disposable therein are correspondingly smallIt can be difficult to handle these small cartridges and to ensure thatthey are fully seated within these small end effectors. The surgicaldevice and the cartridge including the at least one mating element andthe at least one engagement feature can facilitate removable disposal ofthe cartridge within the end effector, even when the cartridge and theend effector have particularly small diameters.

A surgical device can be configured to facilitate removable coupling ofa cartridge to a surgical device's end effector in a variety of ways. Inthe embodiments described below, staples are used as examples offasteners, but as will be appreciated by a person skilled in the art,other types of fasteners can be similarly configured and used.

In some embodiments, a mating element can be in the form of a latch.FIG. 127, FIG. 128, FIG. 129, and FIG. 130 illustrate one embodiment ofa mating element 6014 that includes a latch. In general, the matingelement 6014 can be configured to removably couple to an engagementfeature 6016, thereby facilitating removable seating of a cartridge 6008within an end effector 6004 of a surgical device 6000. The end effector6004 can be coupled to a distal end of the device's elongate shaft 6002,and can include an upper jaw 6020 and a bottom jaw 6008. As discussedherein, one of the jaws 6020, 6018 can include a channel (not shown)formed therein that can be configured to removably seat the cartridge6008 therein. In this illustrated embodiment, the bottom jaw 6018includes the channel configured to releasably and replaceably seat thecartridge 6008.

As in this illustrated embodiment, the surgical device 6000 can includethe mating element 6014, and the cartridge 6008 can include theengagement feature 6016. The mating element 6014 can be formed on adistal portion of the device 6000 adjacent the end effector 6004, andthe engagement feature 6016 can be formed on a proximal portion of thecartridge 6008, as in this illustrated embodiment. In other embodiments,as mentioned above, on the cartridge 6008 can include the mating element6014, e.g., in a proximal portion thereof, and the surgical device 6000can include the engagement feature 6016, e.g., in a distal portionthereof adjacent the end effector 6004. There is only one mating element6014 in this illustrated embodiment and one engagement feature 6016, butone or more mating elements 6014, e.g., two latches, and one or morecorresponding engagement features 6016 can be used.

The latch 6014 and the engagement feature 6016 can each have a varietyof sizes, shapes, and configurations. As in this illustrate embodiment,the latch 6014 can include an arm having a first end fixedly attached tothe device 6000, e.g., to the shaft 6002. The latch 6014 can alsoinclude a second, opposite end freely movable relative to the device6000, e.g., to the shaft 6002 and the end effector 6004, when the latch6014 is not fully mated with the engagement feature. The second end caninclude a protrusion formed thereon and extending radially inward. Thelatch 6014 can be configured to dynamically move in response toinsertion of the cartridge 6008 into the bottom jaw 6018, therebyallowing the latch 6014 to automatically engage the engagement feature6016 when the cartridge 6008 is properly seated within the bottom jaw6018, such as by the latch 6014 snapping into the engagement feature6016. In some embodiments, this snapping can make an audibly detectablenoise, thereby indicating proper seating of the cartridge 6008 withinthe bottom jaw 6018. The latch 6014 can be configured to so dynamicallymove by including a deflectable spring-arm, as in this illustratedembodiment.

As in this illustrated embodiment, the engagement feature 6016 caninclude a notch, also referred to herein as a “cut-out,” configured toreceive the mating element 6014, e.g., the protrusion thereof, therein.The engagement feature 6016 can have a size and shape corresponding to asize and shape of the mating element 6014, e.g., the protrusion thereof,so as to facilitate a tight, secure fit of the mating element 6014within the engagement feature 6016.

In general, the latch 6014 can be configured to extend into theengagement feature 6016 so as to be completely mated thereto. FIG. 127and FIG. 129 show the mating element 6014 mated with the engagementfeature 6016, the cartridge 6008 thus being fully seated within thebottom jaw 6018. The mating element 6014 being completely mated with theengagement feature 6016 can be visually detectable by looking at thedevice 6000, thereby indicating to a user that the device 6000 can beused to fire fasteners (not shown) from the cartridge 6008. The latch6014 can be configured to protrude radially outward beyond an outerdiameter of the shaft 6002 when the latch 6014 is not engaged with,e.g., is misaligned from, the engagement feature 6016. FIG. 128 and FIG.130 show the mating element 6014 unengaged with the engagement feature6016, thereby indicating that the cartridge 6008 is not fully seatedwithin the bottom jaw 6018. The mating element 6014 being incompletelymated with the engagement feature 6016 can be visually detectable bylooking at the device 6000, thereby allowing a user to readjust thecartridge 6008 so as to properly seat the cartridge 6008 in the endeffector 6004. FIG. 128 also shows that the latch 6014 can extend adistance 6006 radially outward from the shaft's 6002 outer surface 6010when the mating element 6014 and the engagement feature 6016 are notengaged together.

The mating element 6014 can be configured to prevent the end effector6004 from being inserted into a patient, e.g., into a body cavitythereof, when the mating element 6014 is not fully mated to theengagement feature 6016. Thus, if a user does not realize that thecartridge 6008 is not properly seated in the bottom jaw 6018 of the endeffector 6004 and tries to insert in the end effector 6004 into thepatient, the mating element 6014 can indicate to the user that thecartridge 6008 is not properly seated in the bottom jaw 6018 and shouldbe readjusted thereto before inserting the end effector 6004 into thepatient for the device 6000 to properly function within the patient,e.g., for the device 6000 to properly fire fasteners therein.

As shown in one embodiment in FIG. 131, the mating element 6014 can beconfigured to prevent the end effector 6004 from being inserted into apatient's tissue 6012 to access a body cavity (not shown) underneath thetissue by abutting an access device 6022 disposed within the tissue 6012through which the end effector 6004 is attempting to be advanced. Theaccess device 6022 includes a trocar in this illustrated embodiment, butother types of access devices can be similarly used, as will beappreciated by a person skilled in the art. The access device 6022 caninclude a port 6024 extending therethrough through which the endeffector 6004 can be inserted. The port 6024 can have a diameter. Theend effector 6004 can have a diameter corresponding to the port'sdiameter in the closed position such that with the mating element 6014extending the distance 6006 radially outward, the end effector's 6004diameter can be effectively increased. This increased diameter canprevent the end effector 6004 from being advanced through the accessdevice 6022. For example, the port's diameter can be configured toaccommodate a device having a 5 mm diameter, and the end effector 6004can have a 5 mm diameter when the cartridge 6008 is fully seated in thebottom jaw 6018. When the cartridge 6008 is not fully seated in thebottom jaw 6018, as shown in FIG. 131, the end effector's diameter canbe effectively increased over 5 mm such that the end effector 6004cannot be fully advanced through the port 6024.

FIG. 132, FIG. 133, and FIG. 134 illustrate another embodiment of amating element that includes a latch configured to removably couple toan engagement feature. In this illustrated embodiment, the matingelement includes first and second latches 6026 a, 6026 b, and theengagement feature includes first and second cut-outs 6028 a, 6028 bconfigured to receive the first and second latches 6026 a, 6026 b,respectively. The first and second latches 6026 a, 6026 b and the firstand second cut-outs 6028 a, 6028 b can generally be configured and usedsimilar to the mating element 6014 and the engagement feature 6016,respectively, of FIG. 127. In this illustrated embodiment, a bottom jaw6030 of an end effector (not shown) includes the first and secondcut-outs 6028 a, 6028 b and includes a channel 6032 configured toreleasably and replaceably seat a cartridge 6034 that includes the firstand second latches 6026 a, 6026 b. However, as mentioned above, in otherembodiments, the end effector or other part of a device that includesthe end effector can include the mating element, and the cartridge 6034can include the engagement feature.

The first and second latches 6026 a, 6026 b can be positioned onopposite lateral sides of the cartridge 6034, and the first and secondcut-outs 6028 a, 6028 b can be correspondingly positioned on oppositelateral sides of the bottom jaw 6030, e.g., on opposite lateral sides ofthe channel 6032. The mating element and the engagement feature beinglocated on lateral sides of the cartridge 6034 and bottom jaw 6030 thatseats the cartridge 6034 can help ensure that the cartridge 6034 is notskewed laterally within the channel 6032.

When the cartridge 6034 is inserted into the channel 6032 in a proximaldirection 6036, as shown in FIG. 133, the first and second latches 6026a, 6026 b can be configured to dynamically move in response to theinsertion, e.g., flex radially inward, as shown in FIG. 134. Insertingthe cartridge 6034 in the proximal direction 6036 allows the cartridge6034 to be easily seated within the cartridge 6034 in one motion. Whenthe first and second latches 6026 a, 6026 b align with the first andsecond cut-outs 6028 a, 6028 b, respectively, the first and secondlatches 6026 a, 6026 b can be configured to snap into the first andsecond cut-outs 6028 a, 6-28 b so as to secure the cartridge 6034 withinthe bottom jaw 6030. FIG. 133 shows the cartridge 6034 fully seatedwithin the channel 6032 of the bottom jaw 6030 with the first and secondlatches 6026 a, 6026 b snapped into the first and second cut-outs 6028a, 6028 b.

In some embodiments, a surgical device can include at least on biasingelement configured to bias a cartridge out of an end effector to whichthe cartridge can be removably coupled. The at least one biasing elementcan facilitate removal of the cartridge from the end effector and/or canbe configured to indicate when the cartridge is not fully seated withinthe end effector. As in this illustrated embodiment, the bottom jaw 6030that seats the cartridge 6034 can include a biasing element 6038 a, 6038b. There are two biasing elements 6038 a, 6038 b in this illustratedembodiment, but a surgical device can include another number of biasingelements. The at least one biasing element 6038 a, 6038 b can have avariety of sizes, shapes, and configurations. As in this embodiment, thebiasing elements 6038 a, 6038 b can include a coil spring. In otherembodiments, the at least one biasing element 6038 a, 6038 b caninclude, e.g., a volute spring, an elastic member similar to a rubberband, a leaf spring, etc. Each of the biasing element 6038 a, 6038 b canbe biased in a distal direction 6038, as shown in FIG. 134.

When the cartridge 6034 is inserted into and seated within the bottomjaw 6030, the cartridge 6034 can compress the biasing elements 6038 a,6038 b, as shown in FIG. 133. If the cartridge 6034 is not fully seatedin the bottom jaw 6030, the bias of the at least one biasing element6038 a, 6038 b can cause the cartridge 6034 to protrude out of thebottom jaw 6030, thereby indicating that the cartridge 6034 is not fullyseated therein. When the cartridge 6034 is removed from the bottom jaw6030, e.g., by pressing the first and second mating elements 6026 a,6026 b radially inward, the biasing elements 6038 a, 6038 b can urge thecartridge 6034 in the distal direction 6040. This urging can cause thecartridge 6034 to extend a distance 6042 distally beyond where thecartridge 6034 is fully seated within the bottom jaw 6030, which canfacilitate grasping of the cartridge 6034 and removal thereof from thebottom jaw 6030. A secondary tool thus need not be used to remove thecartridge 6034 from the bottom jaw 6030.

FIG. 135 illustrates an alternate embodiment of a biasing element 6044a, 6044 b that can be configured and used similar to the biasingelements 6038 a, 6038 b of FIG. 133. The at least one biasing element6044 a, 6044 b in this illustrated embodiment also includes a coilspring. In the embodiment of FIG. 133, the biasing element 6038 a, 6038b extend from an inner surface of the bottom jaw 6030 in the distaldirection 6040. In this illustrated embodiment, the biasing element 6044a, 6044 b each extend from an inner surface of a bottom jaw 6050 thatseats a cartridge 6052 in an upward direction 6046 that is substantiallyperpendicular to a distal direction 6048. The cartridge 6052 can beconfigured to be seated in the bottom jaw 6050 by being advanced in adownward direction 6054 into a channel 6056 thereof. The biasingelements 6044 a, 6044 b can be biased in the upward direction 6046 suchthat when the cartridge 6052 is removed from the bottom jaw 6050, thebiasing elements 6044 a, 6044 b can urge the cartridge 6052 in theupward direction 6046, thereby facilitating grasping and removal of thecartridge 6052 from the bottom jaw 6050.

Instead of a cartridge being removably coupled to an end effectorfixedly attached to an elongate shaft of a surgical device, the endeffector can be removably coupled to the elongate shaft, as will beappreciated by a person skilled in the art. In other words, the endeffector can be modular. The end effector can include a cartridge fixedtherein, although in some embodiments, the end effector can beconfigured to have a cartridge releasably and replaceably seatedtherein. Such a surgical device can include one of at least one matingelement and at least one engagement feature, and such a modular endeffector can include the other of the at least one mating element andthe at least one engagement feature. The at least one mating element andthe at least one engagement feature can generally be configured and usedsimilar to those discussed above.

FIG. 136 illustrates one embodiment of a surgical device that includesan elongate shaft 6058 and a modular end effector 6060 configured toremovably couple to a distal end of the shaft 6058. The end effector6060 in this illustrated embodiment includes a cartridge 6062 fixedlyseated therein. The end effector 6060 can include at least one matingelement 6072 configured to removably couple to at least one engagementfeature 6074 of the shaft 6058. As in this illustrated embodiment, theat least one mating feature 6072 can include one or more protrusions,and the at least one engagement feature 6074 can include one or morenotches that are each configured to seat one of the protrusions therein.Similar to that discussed above, if the at least one mating feature 6072and the at least one engagement feature 6074 are only partially engaged,the end effector 6060 can be prevented from being inserted into apatient. The end effector 6060 includes two protrusions and the shaft6058 includes two notches in this illustrated embodiment, but there canbe a different number of protrusions and corresponding notches. Inanother embodiments, the end effector 6060 can include at least oneengagement feature, and the shaft 6058 can include at least one matingelement.

The shaft 6058 in this illustrated embodiment has a proximal portion6064 of a first drive rod movably positioned therein and a proximalportion 6070 of a second drive rod movably positioned therein. The firstdrive rod can be configured to be actuated at a handle (not shown) ofthe device to effect opening and closing of the end effector 6060, e.g.,opening and closing of the end effector's first and second jaws 6066,6068. The second drive rod can be configured to be actuated at thehandle to effect firing of fasteners (not shown) from the cartridge6062. The end effector 6060 in this illustrated embodiment has a distalportion 6076 of the first drive rod movably positioned therein and has adistal portion 6078 of the second drive rod movably positioned therein,When the at least one mating element 6072 is removably coupled to the atleast one engagement feature 6074 so as to removably couple the endeffector 6060 and the shaft 6058, the proximal and distal portions 6064,6072 of the first drive rod can be in operative contact, and theproximal and distal portions 6070, 6078 of the second drive rod can bein operative contact. A distal end of the first drive rod's proximalportion 6064 can include at least one mating element 6080 configured toremovably mate with a corresponding at least one engagement feature 6082at a proximal end of the first drive rod's distal portion 6076.Similarly, a distal end of the second drive rod's proximal portion 6070can include at least one mating element 6084 configured to removablymate with a corresponding at least one engagement feature 6086 at aproximal end of the second drive rod's distal portion 6078. Although theproximal portions 6064, 6070 include engagement features in thisillustrated embodiment, in other embodiments, the proximal portions6064, 6070 can include engagement features configured to engage withcorresponding mating elements of the distal portions 6072, 6078.

The end effector 6060 can be biased, e.g., spring biased, to an openposition. The second drive rod can be configured such that after thefasteners have been fired from the cartridge 6062, e.g., by distallyadvancing the second drive rod through the cartridge 6062 with the endeffector 6060 in a closed position, the second drive rod can beretracted so as to cause the end effector 6060 to move from the closedposition to the open position. Retracting the end effector 6060 throughan access device through which the end effector 6060 was inserted into apatient's body can be configured to cause the end effector 6060 to movefrom the open position to the closed position so as to allow the endeffector 6060 to be removed from the patient's body, but the biasing ofthe end effector 6060 can cause the end effector 6060 to be in the openposition once removed from the access device. The open position canindicate that the cartridge 6062 should be removed and replaced beforeagain attempting to fire fasteners from the end effector 6060, therebyproviding safety.

In some embodiments, a surgical device such as the above-mentionedsurgical device 1100 can be configured to prevent at least one ofclosure of the end effector and firing of fasteners from the endeffector when a cartridge is not fully seated in the end effector. Thecartridge can be configured to be removably coupled to the end effector,as discussed herein. In some instances, the cartridge can be improperlyloaded into the end effector such that the cartridge is not fully seatedtherein. In some instances, the end effector can be advanced into a bodyof a patient without a cartridge seated in the end effector at all.Preventing closure of an end effector and/or firing of fasteners fromthe end effector when a cartridge is not fully seated in the endeffector can indicate to a user of the device that either the endeffector does not have a cartridge seated therein at all or that thecartridge engaged with the end effector is not fully seated therein. Theuser can thus be aware that the device needs adjustment, either byseating a cartridge therein or readjusting the cartridge alreadyattempted to be seated therein. Preventing closure of an end effectorand/or firing of fasteners from the end effector when a cartridge is notfully seated in the end effector can help prevent the device and/or acartridge partially seated in the end effector from being damaged by anattempt to close the end effector and/or an attempt to fire fasteners.

In an exemplary embodiment, a surgical device including an end effectorconfigured to removably seat a cartridge can include a lockout elementconfigured to prevent at least one of closure of the end effector andfiring of fasteners from the end effector when a cartridge is not fullyseated in the end effector. The lockout element can be configured tomove between first and second positions. The lockout element being inthe first position can indicate that no cartridge is seated in the endeffector or that a cartridge is improperly seated in the end effector.The lockout element being in the second position can indicate that acartridge is fully seated in the end effector. The lockout element canbe configured to dynamically move between the first and secondpositions. Fully seating a cartridge in the end effector can cause thelocking element to dynamically move from the first position to thesecond position. Partial or full removal of a fully seated cartridgefrom the end effector can cause the locking element to move from thesecond position to the first position. The locking element can thus beconfigured to provide an automatic safety feature by being configured toautomatically prevent firing and/or prevent closing of the end effectorif a cartridge is not fully seated in the end effector.

A surgical device can be configured to prevent at least one of closureof the end effector and firing of fasteners from the end effector in avariety of ways. In the embodiments described below, staples are used asexamples of fasteners, but as will be appreciated by a person skilled inthe art, other types of fasteners can be similarly configured and used.

In some embodiments, a lockout element can be in the form of a camplate, also referred to herein as a “shuttle.” FIG. 137 and FIG. 138illustrate one embodiment of a surgical device that can include anelongate shaft 7000 and an end effector 7008 coupled to a distal end ofthe elongate shaft 7000. The end effector 7008 can include a first jaw7002 pivotally coupled to a second jaw 7004 via a pivot pin 7010. Thefirst and second jaws 7002, 7004 in this illustrated embodiment areidentical to the above-mentioned first and second jaws 1110 a, 1110 b,which can be configured to open/close similar to that discussed hereinfor the first and second jaws 7002, 7004, but the device that includesthe first and second jaws 7002, 7004 of this illustrated embodiment alsoincludes a locking element configured to prevent at least one of closureof the end effector 7008 and firing of fasteners (not shown) from theend effector 7008 when a cartridge 7012 is not fully seated in the endeffector 7008. FIG. 137 shows the cartridge 7012 partially seated in thebottom jaw 7002 such that the end effector 7008 cannot close andfasteners cannot be fired from the cartridge 7012. FIG. 138 shows thecartridge 7012 fully seated in the bottom jaw 7002 such that the endeffector 7008 can close, as indicated by an arrow 7024 in a direction ofclosure and by the anvil 7004 in phantom in FIG. 138, and fasteners canbe fired from the cartridge 7012.

As shown in FIG. 137 and FIG. 139, the anvil 7004 can include a firstslot 7018 formed in a proximal portion thereof. The slot 7018 can beconfigured to receive a guide pin 7028 at a distal end of a drive rod7030 configured to translate along the shaft 7000 to effect opening andclosing of the end effector 7004. The guide pin 7028 can be configuredto slide distally within the guide slot 7018 to close the end effector7008 by causing the anvil 7004 to move toward the bottom jaw 7002, andcan be configured to slide proximally within the guide slot 7018 to openthe end effector 7008 by causing the anvil 7004 to move away from thebottom jaw 7002. As shown in FIG. 137 and FIG. 138, the bottom jaw 7002can include a second slot 7020 formed therein. The slot 7020 can beconfigured to slidably receive the guide pin 7028 therein that alsoslides within the first closure slot 7018. The first and second slots7018, 7020 via movement of the guide pin 7028 therein can cooperate tofacilitate opening and closing of the end effector 7004. Although onlyone of each of the first and second slots 7018, 7020 are shown in FIG.137 and FIG. 138, the anvil 7004 can have first slots 7018 formed inopposed lateral sides thereof, and the bottom jaw 7002 can have secondslots 7020 formed in opposed lateral sides thereof.

The bottom jaw 7002 can include a third slot 7022 formed therein thatcan be configured to slidably receive the pivot pin 7010 therein.Although only one of third slots 7022 is shown in FIG. 137 and FIG. 138,the bottom jaw 7002 can have third slots 7022 formed in opposed lateralsides thereof.

The pivot pin 7010 can have a variety of sizes, shapes, andconfigurations. The pin 7010 can be a single pin laterally spanning theend effector 7008, or the pin 7010 can include two pins extendinglaterally. In an exemplary embodiment, the pin 7010 can be attached tothe anvil 7004 in a fixed position relative thereto, and can be movablycoupled to the bottom jaw 7002. The bottom jaw 7002 can have a slot 7014formed therein in which the pin 7010 can be slidably movable. As shownin FIG. 139, the anvil 7004 can have a pin receiving hole 7016 formedtherein configured to fixedly receive the pin 7010 therein.Alternatively, the pin 7010 can be integrally formed with the anvil7004.

As shown in FIG. 140, the pivot pin 7010 can be configured to beslidably received within a cam plate 7026. The cartridge jaw 7002 canthus have two cam plates 7026 disposed therein, one at each of thelaterally opposed second slots 7020 formed in the cartridge jaw 7002.The cam plate 7026 can include a center opening 7030 formedtherethrough. The center opening 7030 can be defined by a bottom wall7030 b, an upper wall 7030 u, a distal wall 7030 d, and a proximal wall7030 p. The center opening 7030 can include a proximal extension 7032 inan upper portion thereof. The proximal end of the center opening 7030can be at a higher position, e.g., more toward the anvil 7004, than theaperture's distal end. The cam plate 7026 can be disposed within thebottom jaw 7002 along an inner surface thereof adjacent the second slot7020.

The cam plate 7026 can include a proximal tail 7034 in a bottom portionthereof. The proximal tail 7034 can be coupled to a bias element 7036,e.g., a coil spring wound around the tail 7034 as in this illustratedembodiment. The bias element 7036 can be configured to bias the camplate 7026 in a distal direction, e.g., away from the proximal extensionsuch that the pin 7010 can be configured to be biased to be in theproximal extension 7032.

The proximal extension 7032 can be configured to seat the pin 7010therein when the end effector 7004 does not have the cartridge 7012fully seated therein, as shown in FIG. 137 and FIG. 140. The biaselement 7036 can facilitate this seating. As the cartridge 7012 is moreproximally positioned within the bottom jaw 7002, the cartridge 7012 canbe configured to move the cam plate 7026 proximally so as to shift aposition of the pin 7010 within the aperture 7030. A length of theproximal extension 7032 in a proximal/distal direction can define howmuch the cam plate 7026 must move proximally before the pin 7010 canexit the proximal extension 7032 so as to move in a downward directiontoward the bottom surface 7030 b of the aperture 7030, as shown in FIG.138 in which the pin 7010 has moved downward to the bottom surface 7030b. The pin 7010 not exiting the proximal extension 7032 can indicatethat the cartridge 7012 has not been fully seated in the bottom jaw7002, as shown in FIG. 137 and FIG. 141, as the cartridge 7012 has notcaused the pin 7010 to exit the proximal extension 7032. The pin 7010being in the proximal extension 7032 can effectively cause the pivotpoint about which the jaws 7002, 7004 pivot to a higher position, whichcan prevent closure of the jaws 7002, 7004.

FIG. 141 also shows that when the cartridge 7012 has not been fullyseated in the bottom jaw 7002, and the end effector 7008 has hence notbeen fully closed, the lockout element can be configured to prevent theend effector 7008 from being inserted into a patient's tissue (notshown) to access a body cavity (not shown) underneath the tissue byabutting an access device 7006 disposed within the tissue through whichthe end effector 7008 is attempting to be advanced. The access device7006 includes a trocar in this illustrated embodiment, but other typesof access devices can be similarly used, as will be appreciated by aperson skilled in the art. The access device 7006 can include a port7038 extending therethrough through which the end effector 7006 can beinserted. The port 7038 can have a diameter. The end effector 7006 canhave a diameter in the closed position corresponding to the port'sdiameter such that with the lockout element locking out closing/firingwhen the cartridge 7012 has been improperly loaded or not loaded at all,the end effector's 7006 diameter can be effectively increased. Thisincreased diameter can prevent the end effector 7006 from being advancedthrough the access device 7006.

FIG. 142 and FIG. 143 illustrate an alternate embodiment of a cam plate7040 that can be configured and used similar to the cam plate 7026 ofFIG. 140. The cam plate 7040 in this illustrated embodiment can includean upper proximal extension 7042 and a lower proximal extension 7044.The cam plate 7040 can include a bias element (not shown) at a proximaltail 7058 thereof. When a cartridge 7046 has been fully seated in acartridge jaw 7048 pivotally coupled at a pivot pin 7052 to an anvil7050, as shown in FIG. 142 and FIG. 144, the pivot pin 7052 can beconfigured to be seated in the upper proximal extension 7042, thereby anI-beam 7052 to be properly aligned with the anvil 7050 so as to allow aguide pin 7054 of the I-beam 7052 to translate along the anvil 7050 in achannel 7056 formed therein to facilitate end effector closing andclamping. When the cartridge 7046 has not been fully seated in thecartridge jaw 7048, as shown in FIG. 143 and FIG. 145, the I-beam 7052,e.g., the guide pin 7054 thereof, can be misaligned from the anvil 7050,e.g., the channel 7056 thereof, thereby preventing the I-beam 7052 fromtranslating through the anvil 7050 such that fasteners cannot be firedfrom the cartridge 7046.

In some embodiments, a lockout element can be in the form of adeflectable member. FIG. 146, FIG. 147, and FIG. 148 illustrate oneembodiment of a surgical device that can include a lockout element inthe form of a deflectable member 7058. The deflectable member 7058 canhave a variety of sizes, shapes, and configurations. As in thisillustrated embodiment, the deflectable member 7058 can include a springmember. The spring member 7058 can include two deflectable arms 7058 a,7058 b extending in a distal direction. The spring member 7058 can beattached to the I-beam 7060, such as by being attached to a bottom sidethereof with the arms 7058 a, 7058 b extending distally therefrom.

The deflectable member 7058 can be configured to automatically move froma first position, in which the deflectable member 7058 is not engagedwith a cartridge 7062, to a second position, in which the deflectablemember 7058 is engaged with the cartridge 7062, in response to thecartridge 7062 being fully seated in a bottom jaw 7064 movably coupledto an upper jaw 7066. The deflectable member 7058 can also be configuredto automatically move from the second position to the first position inresponse to the cartridge 7062 being removed from the bottom jaw 7064.By being configured to automatically engage with and disengage from thecartridge 7062, the deflectable member 7058 can be a passive elementthat does not require positive user action in order for the lockoutmember 7058 to effectively provide lockout when the cartridge 7062 isimproperly seated in the bottom jaw 7064 or is not seated therein atall. When the deflectable member 7058 is in the first position, as shownin FIG. 147, the I-beam 7060 can be prevented from translating throughthe anvil 7050, e.g., by crashing against the anvil 7050 instead oftranslating therealong. When the deflectable member 7058 is in thesecond position, as shown in FIG. 148, the I-beam 7060 can be allowed totranslate through the anvil 7050. The first position can be a defaultposition of the deflectable member 7058 such that the I-beam 7060 can beprevented from translating through the anvil 7050 unless the cartridge7062 is fully seated in the bottom jaw 7064.

The deflectable member 7058 in the second position can be configured toengage the cartridge 7062 in a variety of ways. In an exemplaryembodiment, the deflectable member 7058 can be configured to engage asled 7068 of the cartridge 7062 to which a cutting element 7074 can bemovably coupled, as discussed herein. As in this illustrated embodiment,the deflectable member 7058 can be configured to engage the sled 7068 bythe arms 7058 a, 7058 b by abutting a proximal surface 7070 of the sled7068. As discussed herein, the sled 7068 can have an initial position ata proximal end of the cartridge 7062, as shown in FIG. 146, FIG, 147,and FIG. 148. When the cartridge 7062 has not been fully seated in thebottom jaw 7064, as shown in FIG. 147, the deflectable member 7058 canbe in the first position and not be engaged with the sled 7068, e.g.,not be in contact with the sled's proximal surface 7070. In the firstposition, the deflectable member 7058 can be in a lower position in adirection away from the anvil 7066. In this lower position, thedeflectable member 7058 can be positioned distal to a foot 7072 of theI-beam 7060 and can be positioned in a translation path thereof throughwhich the foot 7072 can be configured to translate to effect firing offasteners (not shown) from the cartridge 7062. When the cartridge 7062is fully seated in the bottom jaw 7064, as shown in FIG. 148, thedeflectable member 7058 can be in the second position and be engagedwith the sled 7068, e.g., be in contact with the sled's proximal surface7070. In the second position, the deflectable member 7058 can be in ahigher position in a direction toward the anvil 7066. In this higherposition, the deflectable member 7058 can be positioned distal to a foot7072 of the I-beam 7060 but be positioned out of the translation paththereof through which the foot 7072 can be configured to translate toeffect firing of the fasteners from the cartridge 7062. The deflectablemember 7058 in the second position can thus allow firing, while thedeflectable member 7058 in the first position can prevent firing.

The deflectable member 7058 being in either the first position or thesecond position can facilitate determination as to whether fastenershave been fired from the cartridge 7062 since the deflectable member'slockout relies on the sled 7068 being in its initial proximal position.For example, if a cartridge from which fasteners have already been firedis loaded into the bottom jaw 7064, the cartridge's sled is already inits distal, fired position. The deflectable member 7058 thus cannotengage the sled and firing cannot occur until the cartridge is removedfrom the bottom jaw 7064 and replaced with another, non-spent cartridge.

In some embodiments, a surgical device such as the above-mentionedsurgical device 1100 can be configured to have an adjustable gap ofspace between a cartridge jaw and an anvil of the device's end effectorwhen the end effector is in a closed position. In general, the endeffector, e.g., the cartridge jaw, can be configured to removably coupleto a cartridge, as discussed herein. The cartridge can be configured todefine the gap of space between the cartridge jaw and the anvil when theend effector is in a closed position. In other words, the gap of spacecan be a function of the cartridge. The gap of space can be a minimumdistance between facing tissue-engaging surfaces of the cartridge jawand the anvil. The end effector can thus be configured to selectivelyaccommodate tissues of different thicknesses since the end effector'stissue gap can be different based upon the specific cartridge loadedtherein. In an exemplary embodiment, the cartridge can include an anvilcoupling member configured to define the gap of space so as to provide aminimum distance between the facing tissue-engaging surfaces of thecartridge jaw and the anvil when the end effector is in the closedposition. The anvil coupling member can form a partial portion of anI-beam configured to translate longitudinally along the end effector, asdiscussed herein. The anvil coupling member forming a partial portion ofthe I-beam can allow the I-beam to be appropriately sized for the tissuegap defined by the anvil coupling member such that the I-beam canproperly translate along the cartridge, e.g., via a foot of the I-beam,”and along the anvil, e.g., via a guide pin of the I-beam. The anvilcoupling member forming a partial portion of the I-beam can result inthe I-beam being different in the surgical device as a function of thecartridge seated in the end effector. The I-beam can thus be configuredto be adjustable so as to correspond to the adjustable gap of spacebetween the end effector's jaws.

A surgical device can be configured to have an adjustable gap of spacebetween a cartridge jaw and an anvil of the device's end effector whenthe end effector is in a closed position in a variety of ways. In theembodiments described below, staples are used as examples of fasteners,but as will be appreciated by a person skilled in the art, other typesof fasteners can be similarly configured and used.

In some embodiments, an anvil coupling member can be in the form of apartial portion of an I-beam. As discussed herein, an I-beam can beconfigured to translate longitudinally along an end effector to firefasteners from a cartridge seated in the end effector. The I-beam can beconfigured to contact the end effector's bottom jaw with a first portionthereof, e.g., with a foot thereof, and the end effector's anvil with asecond portion, e.g., with a guide pin thereof. The anvil couplingmember can include the second portion of the I-beam configured tocontact the anvil such that the cartridge being loaded into the bottomjaw of the end effector can define a gap of space between thecartridge's tissue-engaging surface and the anvil's tissue-engagingsurface.

FIG. 149, FIG. 150, and FIG. 151 illustrate one embodiment of acartridge 8004 that includes an anvil coupling member 8006 coupledthereto. The anvil coupling member 8006 can be configured to moverelative to a housing 8008 of the cartridge 8004 that had fasteners (notshown) disposed therein, as discussed further below. In general, thecartridge 8004 can be configured to be removably coupled to an endeffector 8010 coupled to a distal end of an elongate shaft 8012, such asby being releasably and replaceably seated in a channel 8017 formed in abottom jaw 8000 of the end effector 8010. The cartridge 8004 can also beconfigured to be releasably and replaceably seated in a slot 8018 formedin an anvil 8002 of the end effector 8010, such as by coupling the anvilcoupling member 8006 thereto. The anvil coupling member 8006 can beconfigured to slidably move within the slot 8018 as part of an I-beam8014, shown in FIG. 152.

The anvil coupling member 8006 can have a variety of sizes, shapes, andconfigurations. As in this illustrated embodiment, the anvil couplingmember 8006 can include a protrusion extending upwardly from thecartridge 8004 so as to extend above a tissue-engaging surface 8000 a ofthe cartridge 8004. This protrusion can includes a guide pin 8016extending laterally from the protrusion and being configured to slidablymove with the anvil's slot 8018.

As in this illustrated embodiment, the anvil coupling member 8006 caninclude a proximal portion of the I-beam 8014. The anvil coupling member8006 can include a first coupling element 8024 configured to removablycouple to a second coupling element 8026 of a remainder of the I-beam8014, e.g., a distal portion of the I-beam 8014. The distal portion ofthe I-beam 8014 in this illustrated embodiment includes a foot 8020 ofthe I-beam 8014, but in other embodiments, the anvil coupling member8006 can include the foot 8020. As in this illustrated embodiment, thefirst coupling element 8024 includes at least one depression formed in aproximal side of the anvil coupling member 8006, and the second couplingelement 8026 can include at least one protrusion formed in a distal sideof the remainder of the I-beam 8014. In other embodiments, the firstcoupling element can include at least one protrusion, and the secondcoupling element can include at least one depression. When the cartridge8004 is fully seated in the cartridge jaw 8000, as shown in FIG. 152,the first and second coupling elements can be coupled together so as toallow the I-beam 8014 include the anvil coupling member 8006 and theremainder of the I-beam 8014 to move as a single unit through the endeffector 8004.

The anvil coupling member 8006 can be configured to define a distance8022 between the tissue-engaging surface 8004 a of the cartridge 8004and a tissue-engaging surface 8002 a of the anvil 8002. As shown in FIG.152, a height of the anvil coupling member 8006, can define a distancethat the anvil coupling member 8006 extends above the cartridge's tissueengaging surface 8004 a and can define how far away the anvil 8002 canbe from the bottom jaw 8000 when the end effector 8010 is in the closedposition based on a location of the guide pin 8016 on the anvil couplingmember 8006. The anvil coupling member 8006 can thus be configured tohelp ensure that the guide pin 8016 can slide within the slot 8018 whenthe end effector 8010 is in the closed position, thereby allowing forfiring of the fasteners.

As shown in FIG. 149 and FIG. 150, the cartridge 8004 can be configuredto be advanced into the channel 8017 of the bottom jaw 8000simultaneously with the guide pin 8016 being advanced in a proximaldirection into the slot 8018 of the anvil 8002. The guide pin 8016 canthus be properly seated within the slot 8018 when the cartridge 8004 isfully seated in the bottom jaw 8000.

FIG. 153 illustrates an alternate embodiment of an anvil coupling member8026 that can be configured and used similar to the anvil couplingmember 8006 of FIG. 149. The anvil coupling member 8026 in thisillustrated embodiment includes a foot 8028 of an I-beam 8030 of whichthe anvil coupling member 8026 can form a proximal portion thereof.

As in this illustrated embodiment, the I-beam 8030 can be configured tobe automatically released from an anvil 8032 such that the I-beam 8030need not be retracted after advancing through the anvil 8032 and acartridge jaw 8036 coupled thereto so as to fire fasteners 8038 intotissue 8040 clamped in a tissue gap 8042 between the anvil 8032 and thecartridge jaw 8036. The I-beam 8030 is configured to advance in a distaldirection 8044 to fire the fasteners 8038 in this illustratedembodiment. The anvil 8032 can include an opening 8038 adjacent a distalend thereof configured to release the anvil coupling member 8026, e.g.,a guide pin 8034 thereof, therefrom. The anvil coupling member 8026, andhence the I-beam 8030, can be configured to be automatically released8042 from the anvil 8032 by the guide pin 8034 passing out of theopening 8038, which can be in communication with a slot in the anvil8032 through which the guide pin 8034 can translate. The release of theanvil coupling member 8026, and hence the I-beam 8030, from the anvil8032 can allow the anvil 8032 to open.

In some embodiments, a shim of a cartridge configured to be removablycoupled to a bottom jaw of an end effector of a surgical device can beconfigured to define a gap of space between the bottom jaw and an anvilcoupled thereto. In general, a size of the shim can define the gap ofspace. The larger the shim, the smaller the gap of space.

FIG. 154 and FIG. 155 illustrate one embodiment of a cartridge 8046 thatincludes a shim 8048. The cartridge 8046 can be configured to removablycoupled to a cartridge jaw 8050 by being seated in a channel 8052 formedtherein. The shim 8048 can have a variety of sizes, shapes, andconfigurations. As in this illustrated embodiment, the shim 8048 caninclude an upwardly extending protrusion that can be formed on a bottominner surface of the cartridge 8046. The shim 8048 can extend along alongitudinal length of the cartridge 8046

The cartridge jaw 8050 can include a receiving slot 8054 formed thereinthat can be configured to slidably receive the shim 8048 therein. Thecartridge 8046 can be configured to be seated within the channel 8052 bysliding the cartridge 8046 in a proximal direction 8058 with the shim8048 sliding proximally within the slot 8054. The shim 8048 can therebydefine a height 8062 of a gap of space 8064, shown in FIG. 155, betweenthe cartridge jaw 8050 and an anvil 8060 coupled thereto. The shim 8048extending along the cartridge's longitudinal length can help the shim8048 define the height 8062 consistently along the end effector'slongitudinal length.

A height 8064 of the shim 8048 can define the tissue gap's height 8062.By way of comparison, FIG. 156 shows a cartridge 8066 without a shimseated in a cartridge jaw 8068 coupled to an anvil 8070. A height 8072of a tissue gap 8074 can thus be greater than the tissue gap's height8062 defined by the shim 8048 of FIG. 155.

FIG. 157 illustrates another embodiment of a cartridge 8076 thatincludes a shim 8078. The shim 8078 can be generally configured and usedsimilar to the shim 8048 of FIG. 154. The shim 8078 in this illustratedembodiment has a height 8080 that is greater than the height 8064 of theshim 8048 of FIG. 155. Thus, a height 8082 of a tissue gap 8084 can beless than the tissue gap's height 8062 defined by the shim 8048 of FIG.155.

In some embodiments, a cutting element of a sled can be configured todefine a gap of space between a bottom jaw and an anvil coupled thereto.As discussed herein, the sled can be part of a cartridge configured tobe removably coupled to an end effector of a surgical device. Thecartridge can thus be configured to define the gap of space.

FIG. 158 illustrates one embodiment of a cutting element 8088 configuredto define a gap of space (not shown) between jaws of an end effector(not shown). The cutting element 8088 can be part of a sled (not shown)of a cartridge (not shown) configured to be removably coupled to an endeffector (not shown), as discussed herein. The cutting element 8088 caninclude an I-beam mating feature 8090 formed on a proximal side thereof,opposite to a blade 8104 formed on a distal side thereof. The I-beammating feature can include a ramped surface 8090 that can slope upwardin a distal direction 8094 toward a pin stop depression 8092 that canextend in the distal direction 8094. The I-beam mating feature 8090 canbe configured to removably couple to an I-beam 8096. The I-beam 8096 caninclude a guide pin 8098 configured to be movable relative to aremainder of the I-beam 8096. As in the illustrated embodiment, theI-beam 8096 can include an I-beam pin slot 8100 in which the pin 8098can be configured to slide. The pin slot 8100 can extend in anupward/downward or vertical direction 8102 that can be substantiallyperpendicular to the distal direction 8094. The pin 8098 can thus beconfigured to slide in the slot 8100 in the upward/downward direction8102.

The pin 8098 can be configured to engage the cutting element 8088 whenthe cartridge including the cutting element 8088 is removably coupled tothe end effector that is attached to an elongate shaft (not shown) alongwhich the I-beam 8096 extends. The pin 8098 can be configured to engagea lower portion of the ramped surface 8090 of the cutting element 8088and slide upward therealong until the pin 8098 reaches the depression8092, which can cause the pin's sliding to stop. The depression 8092 canseat the pin 8098 therein. An upward/downward location of the pin 8098can thus be defined by the cutting element 8088. The guide pin 8098seated in the depression 8092 can be configured to slide along an anvilof the end effector. In this way, a tissue gap between the anvil and acartridge jaw of the end effector can be defined by the cutting element8088.

FIG. 158 illustrates another embodiment of a cutting element 8088′ thatcan be configured and used similar to the cutting element 8088. FIG. 158also illustrates another embodiment of a cutting element 8088″ that canbe configured and used similar to the cutting element 8088. The rampedsurfaces 8090, 8090′, 8090″ of the cutting elements 8088, 8088′, 8088″,respectively, can all start at a same location in a downward direction,thereby facilitating engagement of the pin 8098 with the ramped surfaceof the cutting element loaded into the surgical device's end effector.The cutting element 8088′ has a longer ramped surface 8090′ than thecutting element 8088 such that a depression 8092′ of the cutting element8088′ is located at a higher location than the depression 8092 of thecutting element 8088. The pin 8098 seated in the depression 8092′, asshown in FIG. 159, can thus be up higher than the pin 8098 when seatedin the lower depression 8092. The tissue gap can thus be greater whenusing the cutting element 8088′ versus the cutting element 8088. Thecutting element 8088″ has a longer ramped surface 8090″ than the cuttingelement 8088 and the other cutting element 8088′ such that a depression8092″ of the cutting element 8088″ is located at a higher location thanthe depression 8092 of the cutting element 8088 and the depression 8092′of the cutting element 8088′. The pin 8098 seated in the depression8092″ can thus be up higher than the pin 8098 when seated in either ofthe lower depressions 8092, 8092′. The tissue gap can thus be greaterwhen using the cutting element 8088″ versus the cutting element 8088 andversus the cutting element 8088′.

FIG. 160 and FIG. 161 illustrates another embodiment of a cuttingelement 8106 that can be configured and used similar to the cuttingelements 8088, 8088′, 8088″ and removably couple to the I-beam 8096.FIG. 160 shows the I-beam 8096 disengaged from the cutting element 8106.FIG. 161 shows the pin 8098 of the I-beam 8096 seated in a depression8108 of the cutting element's mating feature 8110.

In some embodiments of a surgical device in which a cutting element of asled can be configured to define a gap of space between a bottom jaw andan anvil coupled thereto, the surgical device can include a push rodconfigured to facilitate engagement of the I-beam's pin with the cuttingelement. The push rod can help ensure that the pin is seated within adepression of the cutting element's mating feature, thereby helping toensure that the anvil is at an intended position relative to the bottomjaw when the bottom jaw and the anvil are closed. The push rod can helphold the pin within the depression, which can help prevent the pin fromshifting position relative to the cutting element. The tissue gap canthus be less likely to change once the pin is seated in the depression.

FIG. 162, FIG. 163, and FIG. 164 illustrate one embodiment of a push rod8112 configured to removably couple to the guide pin 8098 to facilitateengagement of the pin 8098 with the cutting element 8088′. Although thepush rod 8112 is shown with the I-beam 8096 and the cutting element8088′ of FIG. 159, the push rod 8112 can be similar used with otherI-beams and other cutting elements. The push rod 8112 can have a varietyof sizes, shapes, and configurations. As in this illustrated embodiment,the push rod 8112 can include an elongate bar having a forked distal end8114. The fork's tines can define spaces therebetween, each of which canbe configured to removably seat the pin 8098 therein. The forked distalend 8114 in this illustrated embodiment includes four tines definingthree spaces therebetween, but a push rod can include another pluralnumber of tines to define at least one space.

In use, after the cartridge including the cutting element 8088′ has beenseated in the end effector so as to mate the pin 8098 with the cuttingelement's mating feature, as shown in FIG. 162 and FIG. 163, the pushrod 8112 can be advanced in a distal direction 8116 until the forkeddistal end 8114 engages the pin 8098 so as to seat the pin 8098 in oneof the spaces. FIG. 164 shows the pin 8098 seated in the depression8092′ and seated in a middle one of the push rod's spaces. Continuedmovement of the push rod 8112 in the distal direction 8116 can cause theI-beam 8096 and the sled including the cutting element 8088′ to advancedistally, thereby firing fasteners from the cartridge.

In some embodiments, a surface of a cartridge can be configured todefine a gap of space between a bottom jaw and an anvil coupled thereto.As discussed herein, the cartridge can be configured to be removablycoupled to an end effector that includes the bottom jaw and the anvil.The cartridge can thus be configured to define the gap of space.

FIG. 165 illustrates one embodiment of a cartridge 8118 configured todefine a gap of space (not shown) between jaws of an end effector (notshown). In general, the cartridge 8118 can cooperate with an I-beam 8122removably engageable with the cartridge 8118 to define the gap of space.The cartridge 8118 can include a proximal sloped surface 8120 thatslopes upward in a distal direction. The sloped surface 8120 can beconfigured to engage a guide pin 8124 of the I-beam 8122 to facilitatepositioning of the guide pin 8124 relative to the cartridge 8118 and,hence, to an anvil 8119, shown in FIG. 168. The guide pin 8124 of theI-beam 8122 can be configured to be movable relative to a remainder ofthe I-beam 8122.

As in the illustrated embodiment, the I-beam 8122 can include an I-beampin slot 8126 in which the pin 8124 can be configured to move. TheI-beam 8122 can include a bias element 8132 configured to bias the pin8124 toward a bottom surface of the slot 8126, as shown in FIG. 165 andin FIG. 166. The bias element 8132 includes a coil spring in thisillustrated embodiment, but the bias element 8132 can have otherconfigurations. The pin slot 8126 can extend in an upward/downward orvertical direction 8128 that can be substantially perpendicular to aproximal/distal direction 8130 in which the I-beam 8122 can beconfigured to translate through the cartridge 8118. The pin slot 8126can include a plurality of notches formed therein on a proximal sidethereof, as also shown in FIG. 167. The pin slot 8126 includes threenotches in this illustrated embodiment, but a pin slot can includeanother number of notches. Each of the notches can be configured to seatthe pin 8124 therein, the one of the notches depending on the slopedsurface 8120 of the cartridge 8118. The pin 8124 can thus be configuredto move in the slot 8126 in the upward/downward direction 8128 and inthe proximal/distal direction 8130.

The pin 8098 can be configured to engage the sloped surface 8020 whenthe cartridge 8118 is removably coupled to the end effector that isattached to an elongate shaft (not shown) along which the I-beam 8122extends. The pin 8124 can be configured to engage and slide upward anddistally along the sloped surface 8020 until the pin 8124 reaches a topend of the sloped surface 8020, e.g., until the sloped surface 8020ends. The force of the sloped surface 8020 on the pin 8124 can exceed aforce provided by the bias element 8132, thereby allowing the pin 8124to slide along the sloped surface 8020 and move upward within the slot8126. When the pin 8124 reaches the top end of the sloped surface 8020,e.g., when the cartridge 8118 has been fully seated in the end effector,the pin 8124 can automatically move proximally so as to be seated in oneof the notches. With the pin 8124 seated in the one of the notches, theI-beam 8122 can be advanced distally so as to fire fasteners (not shown)from the cartridge 8118 with the tissue gap defined by the pin'svertical location within the slot 8126.

FIG. 165 illustrates another embodiment of a cartridge 8118′ that can beconfigured and used similar to the cartridge 8118. FIG. 165 alsoillustrates another embodiment of a cartridge 8118″ that can beconfigured and used similar to the cartridge 8118. In this illustratedembodiment, the cartridge 8118 has a first size, e.g., a firstlongitudinal length and a first height, the cartridge 8118′ has a secondsize, e.g., a second longitudinal length greater than the firstlongitudinal length and a second height greater than the first height,and the cartridge 8118″ has a third size, e.g., a third longitudinallength greater than the second longitudinal length and a third heightgreater than the second height. The sloped surfaces 8120, 8120′, 8120″of the cartridges 8118, 8118′, 8118″, respectively, can all start at asame location in a downward direction, thereby facilitating engagementof the pin 8124 with the sloped surface of the cartridge loaded into thesurgical device's end effector. The cartridge 8118′ has a longer andsteeper ramped surface 8120′ than the cartridge 8118 such that the pin8124 can move into one of the notches at a higher location than with thecartridge 8118. The pin 8124 seated in a middle one of the notches 8125in response to the cartridge 8118′, as shown in FIG. 168, can thus be uphigher than the pin 8124 when using the cartridge 8118. The tissue gapcan thus be greater when using the cartridge 8118′ versus the cartridge8118. The cartridge 8118″ has a longer and steeper sloped surface 8120″than the cartridge 8118 and the other cartridge 8118′ such that the pin8124 can move into one of the notches at a higher location than with thecartridge 8118 and than with the cartridge 8118′. The pin 8124 seated inthe notch in response to the cartridge 8118″ can thus be up higher thanthe pin 8124 when using either of the cartridge 8118, 8118′. The tissuegap can thus be greater when using the cartridge 8118″ versus thecartridge 8118 and versus the cartridge 8118′.

In some embodiments, a surgical device such as the above-mentionedsurgical device 1100 can be configured to self-retract in the event ofmisfiring conditions, i.e., partial firing, jamming, etc. In general,the surgical device's end effector 1106 can be configured to engagetissues of various types and thicknesses. For example, in an endoscopicoperation, the end effector 1106 portion of the device may be insertedinto a patient to access a surgical site. A surgeon may refer to anendoscopic or other diagnostic imaging device to position tissue betweenthe first and second jaws 1110 a, 1110 b of the end effector 1106. Thesurgeon may repeatedly grasp and position the tissue until the tissue isproperly positioned between the jaws of the end effector 1106, and thetissue can then be clamped and locked in the end effector 1106. If theclamping is proper, and the tissue type and thickness is appropriate forthe end effector, the surgeon may proceed with firing the surgicalstapling and cutting element 1134. Specifically, the surgeon grasps themovable trigger 1122 and the handle 1102, depressing the movable trigger1122 a predetermined number of times. The number of firing strokesnecessary may be ergonomically determined based on a maximum hand size,maximum amount of force to be imparted on the instrument during eachfiring stroke, and the longitudinal distance and force needed to betransferred through a drive shaft to the end effector 1106 duringfiring.

The drive shaft is coupled to a drive beam (also referred to herein as a“drive rod” or an “I-beam”) disposed within the end effector 1106 andconfigured to assist in driving fasteners (e.g., staples) into a tissue,as well as pushing a cutting element through the tissue. However, thedrive beam may, in some instance, jam or only partially fire. This canbe caused by a number of factors, including the cutting element 1134becoming jammed on an improperly clamped tissue and/or a condition whenthe clamped tissue thickness is so great as to prevent the fastenersfrom being completely deployed and/or to prevent the cutting elementfrom fully passing through tissue. A jammed or stuck drive beam can leadto confusion and unnecessary downtime during an operation and mayrequire the surgeon to remove the end effector 1106 from the surgicalsite to resolve the problem, which can be a complex procedure toperform. Surgical devices configured to easily and quickly correct amisfiring condition without removing the end effector 1106 from thesurgical site can help reduce surgery downtime and improve a surgeon'sefficiency.

A surgical device can include a retraction mechanism configured toretract the drive beam from a jammed position in a variety of ways. Asdiscussed below, various mechanisms are provided to easily correct amisfiring condition with minimal interruption to the surgical procedure.

FIG. 169 illustrates one embodiment of a surgical fastening device 9000having a retraction mechanism configured to manually and positivelyretract a jammed or misfired drive beam (and associated components).Fastening device 9000, similar to fastening device 1100 shown anddescribed above, includes a proximal handle portion 1102 and an elongateshaft 1104 extending therefrom. Although FIG. 169 is truncated, itincludes an end effector (not shown) at a distal end of shaft 1104, asshown and described above with respect to device 1100. The handleincludes a stationary handle 1124 and a movable trigger 1122, which asdescribed above can be manipulated to effect the closing of the jaws ofthe end effector and the firing of staples from one of the jaws throughaction imparted to a drive shaft within the handle and a drive beamwithin the shaft as described above. Fastening device 9000 alsoincludes, on a portion of handle housing 1102, an indicator 9024configured to indicate a relative position of the drive beam, as will bedescribed in more detail below.

Surgical fastening device 9000 also includes mechanisms to effect amanual retraction of the drive shaft and drive beam in the event ofjamming or misfiring, as will be described in more detail below. Onemanual retraction element includes a knob or lever 9026 that isconfigured to slide linearly within a slot 9027 formed in the handlehousing. While FIG. 169 illustrates only one side of the handle, it isunderstood that knob or lever 9026 can be on a single side of the handleor that each side of the handle can include a knob or lever to effectmanual retraction. Another manual retraction element includes a movablelever 9030, shown for purposes of example only on a top portion of thehandle housing. As will be described below, manual actuation of lever9030 between a normal position 9030 a and an actuated position 9030 b,shown in phantom, will effect manual and positive retraction of thedrive shaft and drive beam.

FIG. 169 and FIG. 170 illustrate one embodiment in which the surgicaldevice 9000 can include a retraction mechanism 9001 and retraction toolthat is integrated into the surgical device 9000. As described above, adrive shaft 9002 extends through the elongate shaft 1104, and isoperably coupled to a drive beam and movable trigger 1122 to effect jawclosure and staple firing. Drive features 9003 are formed on one side(e.g., a bottom side) of the drive shaft 9002 and are configured tointeract with features on or coupled to the movable trigger 1122 toeffect distal movement of the drive shaft for purposes of closing thejaws and firing staples. Another surface of the drive shaft 9002 (e.g.,a top surface) includes one or more retraction features configured toassist in the retraction of a drive beam (not shown) coupled to thedrive shaft 9002. As illustrated in FIG. 169, retraction features can bein the form of a toothed rack 9005, which can be formed on one side ofthe drive shaft 9002 facing an opening 9004 on the outer casing(partially shown) of the surgical device 9000. The toothed rack 9005 isconfigured to interact with a retraction mechanism to move the driveshaft 9002 in a proximal direction, thereby retracting the drive beam.In an exemplary embodiment illustrated in FIG. 169 and FIG. 170, theretraction mechanism can be integrated with the fastening device. Forexample, the retraction mechanism can be in the form of an integratedlever 9030 that is coupled to a pawl 9012. As illustrated, the pawl 9012includes at least one tooth 9014 configured to engage individual racksof a toothed rack 9005 formed on a drive shaft 9002. FIG. 170illustrates the lever 9030 in a normal position 9030 a in which itassumes a low profile to maintain a more sleek design of the tool,enabling more convenient storage, packaging, and handling of the device.The lever 9030 can be moved in a distal direction, as shown in FIG. 169,to an actuated position 9030 b, shown in phantom in FIG. 169. As aresult of movement of the lever 9030 to the actuated position, the pawl9012 engages the toothed rack 9005 and moves the drive shaft proximally,thereby retracting the drive beam.

FIG. 171 illustrates another embodiment of a retraction mechanism 9009with a removable retraction tool. It is understood that the retractionmechanism components of FIG. 171 can be incorporated into a surgicalfastening device 9000 of the type shown in FIG. 169. Like the retractionmechanism described with reference to FIGS. 169 and 170, the retractionmechanism 9009 utilizes a toothed rack 9005′ formed on one side (e.g., atop surface) of drive shaft 9002. The retraction mechanism 9009 furtherincludes a gear 9006 having at least one tooth configured to engageindividual teeth of the toothed rack 9005′. By applying a rotationalforce to the gear 9006, the gear 9006 engages the toothed rack 9005′ andcan advance the drive shaft 9002 either distally or proximally in alinearized fashion. For purposes of retracting the drive beam, the gearcan rotate in a counter clockwise direction to move the drive shaft 9002proximally, thereby retracting the drive beam. It is understood that thepawl and toothed rack can be designed to enable complete retraction ofthe drive beam with a single actuating movement of the lever 9030, orwith multiple actuating movements of the lever.

The gear 9006 can be actuated in a number of ways using a variety ofretraction tools. For example, an integrated lever of the type describedabove with respect to FIG. 169 and FIG. 170 can be used. In anotherembodiment, however, illustrated in FIG. 171, a removable wrench 9008serve as a retraction tool. Removable wrench 9008 can extend through theopening 9004 formed in the handle housing and can be coupled to the gear9006 by, for example, mounting onto a bolt 9010 on the gear 9006. Onceconnected to the gear, rotation of the removable wrench 9008 in acounter clockwise direction, effects a counter clockwise rotation of thegear as a result of the teeth on the gear 9006 engaging the toothed rack9005′ to move the drive shaft 9002 linearly in a proximal direction.Such movement of the drive shaft causes proximal movement of the drivebeam, thereby retracting the drive beam. It is understood that the gearand toothed rack can be designed to enable complete retraction of thedrive beam with a single actuating movement of the wrench 9008, or withmultiple actuating movements of the wrench.

The embodiment illustrated in FIG. 171 advantageously provides a manualretraction method without having to integrate a retraction tool (e.g.,wrench 9008) into the device 9000. The device 9000 can achieve a smallersize and be lighter in weight and easier to handle using a removableretraction tool such as wrench 9008.

A person skilled in the art will appreciate that the embodiments of FIG.169, FIG. 170, and FIG. 171 provide mechanisms that conveniently enablethe positive and manual retraction of a drive beam in the event of ajamming or misfiring condition. As described above, actuation of theretraction mechanism applies a counter rotating torque that retracts thedrive shaft and drive beam. Both the lever and the wrench describedabove enable a user to apply a large moment arm to effect retraction. Itwill be further understood that retracting the drive shaft 9002 merelypushes a movable trigger 1122 back to a parked, pre-firing positionwhere the surgical device 9000 is immediately ready for another round offiring, therefore causing no interruption to the stapling operation.

In some embodiments the surgical device 9000 may include mechanism forproviding the surgeon with an indication of how far a drive shaft hasbeen advanced and retracted. The surgeon can determine the relativepositions of the drive shaft and/or the drive beam and thereby determinehow many strokes of the movable trigger 1122 are required to complete afiring. As shown in FIG. 169 and FIG. 172, an indicator 9024 in the formof a knob or dial with an indicator needle 9028 is utilized to provideto the surgeon information about the relative position of the driveshaft 9002. As illustrated, the needle 9028 is configured to rotate inresponse to firing stroke action. As illustrated in FIG. 172, theindicator knob 9024 can be marked in increments of 0-4 indicating driveshaft 9002 and/or movable trigger 1122 positions to the surgeon.Increment 0 is indicative of pre-firing positions for the drive shaft9002 and the movable trigger 1122 while increment 4 is indicative ofcomplete firing. As the movable trigger 1122 is compressed for eachfiring stroke to close the jaws and/or fire or deploy the fasteners, theneedle 9028 can rotate through increments 0-4 indicating to the surgeonthe positions of the shaft 9002 and/or the trigger 1122, as well as thenumber of strokes remaining to complete a full firing. In theillustrated example, a full firing travel of a drive shaft 9002 requiresfour firing strokes and thus the needle 9028 rotates one increment shownon indicator 9024 for each stroke.

At any time during a procedure, where retraction might be necessary, thesurgeon can ascertain the relative position of the drive shaft and electto utilize a bailout or retraction mechanisms, such as lever 9030 orwrench 9008, to retract the drive shaft 9002.

In some embodiments, a surgical device such as the above-mentionedsurgical fastening device 9000 can be configured to prevent a partiallyformed fastener from remaining in the tissue without being fully formed.Fasteners can have a tendency to form only partially when deployed intoa tissue due to factors such as the tissue type, tissue thickness, shapeof the fastener (e.g., a curved shape thereof), and a strength of a biasurging a fastener into a certain position or configuration. A partiallyformed fastener can detach from the tissue and potentially cause harm toa patient. As such, a surgical device with features configured toretrieve partially formed fasteners can help improve the surgicaloutcome and the overall wellbeing of the patient.

In the embodiments described below, staples are used as examples offasteners, but as will be appreciated by a person skilled in the art,other types of fasteners can be similarly configured.

In some embodiments, a surgical device can include one or more featuresconfigured to retrieve partially formed staples thereby preventing thestaples from remaining in the tissue. In general, staples can bedeployed or driven into a tissue when pushed by a sled coupled to adrive beam, where the drive beam can be configured to receive drivingforce from a drive shaft. FIG. 173 illustrates two embodiments of a sled9034, 9036 that includes one or more mating features 9038, 9040configured to retrieve partially formed staples. The staples 9032 ₁,9032 ₂ in this illustrated embodiment are generally configured like thepreviously described staple 1116 and each have a D-shape with a pointedtip, a first leg 9042 ₁, 9042 ₂ that is substantially straight and asecond leg that is curved. The pointed tip can be a terminal end of thesecond leg, as in this illustrated embodiment. In one embodiment, thestaple 9032 ₁ can include one or more mating features 9044 ₁ configuredto engage the mating feature 9038 on the sled 9034. As illustrated, themating feature 9038 can be in the form of a barb or tooth formed on anupper surface of the sled 9034 that is configured to be in contact withthe staple 9032 ₁. In one embodiment the barb is oriented in a directionthat coincides with the direction in which the staple 9032 ₁ is deployedinto tissue. The mating feature 9044 ₁ can be formed on an out facingsurface of the first leg 9042 ₁ in the form of a cavity configured toreceive the mating feature 9038. In this illustrated embodiment, thestaple 9032 ₁ will rotate clockwise into the tissue when being driven bythe sled 9034 and drive beam 9046. When the staple 9032 ₁ fully formedinto the tissue, the staple 9032 ₁ will have reached a height such thatthe mating feature 9044 ₁ is dis-engaged from the mating feature 9038.Otherwise, when the staple 9032 ₁ is only partially formed and does notrotate fully into the tissue in a clockwise fashion, the mating features9044 ₁ and 9038 will remain engaged and the staple 9032 ₁ will beretrieved when the sled 9034 is retracted by the drive beam 9046.

In another embodiment illustrated in FIG. 173, a mating feature can bein the form of a toothed rack 9040 with one or more teeth oriented in adirection that coincides with the direction in which the staple 9032 ₂is deployed into tissue. Furthermore, a mating feature 9044 ₂ can beformed on an out facing surface of the first leg 9042 ₂ of the staple9032 ₂ in the form of another toothed rack configured to receive themating feature 9040. The two mating features 9044 ₂, 9040 can begenerally configured and used similar to the two mating features 9038,9042 ₁ illustrated above. The staple 9032 ₂ illustrated in thisembodiment will similarly be retrieved by the sled 9036 unless fullyformed into the tissue.

The fastening device 9000 can also include safety features designed toensure that a cutting element, such as knife blade, is not positioned insuch a manner as to accidently or inadvertently cut tissue. In someinstances, when a partial fastener line is deployed the cutting element1134 can be left in the “upright position,” (see FIG. 176, for example)which may lead to accidental cutting of a user of the device 9000 orpremature cutting of tissue engaged by the end effector 1104. In anexemplary embodiment, a cutting element can include features configuredto return the cutting element to the “stowed position,” where the bladecan be generally obscured and in an inoperative position.

FIG. 174, FIG. 175, FIG. 176, and FIG. 177 illustrate one embodiment ofa cutting element 9046 with one or more features configured to rotatethe cutting element 9046 between the upright and stowed or inoperativeposition. As illustrated in FIG. 174, the cutting element 9046 includesa first cam element 9048 oriented generally perpendicular to a blade9052 and a second cam element 9050 oriented generally parallel to theblade 9052, where both the first 9048 and second 9050 cam elements areformed on a proximal end of the cutting element 9046. The cuttingelement 9046 further includes a pivot element 9054 such that the blade9052 is configured to rotate around the pivot element 9054. FIG. 175illustrates an exemplary embodiment in which the cutting element 9046 iscoupled to a sled 9056 at the pivot element 9054, e.g., by a pin.Furthermore, a drive beam 9058 configured to advance distally canprovide bias to the cutting element 9054 by engaging the first 9048 andthe second cam element 9050 with an engagement feature 9060. As shown inFIG. 175, FIG. 176, and FIG. 177, the engagement feature 9060 can be aprotrusion extending from underneath the drive beam 9058 configured topush or pull the cam elements 9048, 9050. For example, when the drivebeam 9058 is advanced distally (FIG. 176), the engagement feature 9060can push upon the second cam element 9050, causing the cutting element9046 to rotate clockwise from a stowed, pre-firing position (FIG. 175)and transition into the upright position, where the blade 9052 becomesoperative as it faces in the distal direction. Conversely, when thedrive beam is being pulled proximally, such as in the event ofretraction, the engagement feature 9060 can pull on the first camelement 9048, causing the cutting element 9046 to rotatecounterclockwise and transition into the stowed position, where theblade 9052 become generally obscured, e.g., oriented generallydownwardly as shown in FIG. 177.

The surgical fastening device 9000 can also include other features, suchas audible indicators of the position or condition of the device withrespect to closing or firing. In one embodiment, an indicator featurecan be in the form of an audible indicator mechanism. As illustrated inFIG. 178 and FIG. 179, a needle 9062, or a similar device, is configuredto generate audible indicator sounds upon interacting with a desiredregion of a drive shaft 9002. In an exemplary embodiment, the driveshaft 9002 can include a surface disruption formed on one surfacethereof toothed rack 9066 that can interact with a device, such as aneedle 9062, to provide a signal, e.g., an audible signal, which can besensed by a surgeon. The surface disruption can be of any type that willinteract with the needle 9062 (e.g., by causing it to bend, deflect,brush against) in one embodiment the surface disruption is a toothedrack 9066 formed on an upper surface of the drive shaft 9002, such as ata proximal end thereof. The toothed rack 9066 includes at least onetooth configured to interact with the needle 9062, which can bepositioned above and adjacent to the surface disruption on the driveshaft such that the needle will contact the surface disruption andgenerate a signal (e.g., an audible signal) when the needle and thesurface disruption interact. In operation, when the surgical fasteningdevice is driving fasteners into a tissue, the drive shaft 9002 willadvance linearly in a distal direction, e.g., by about 30 mm. As thedrive shaft 9002 advances, the toothed rack 9066 will eventually comeinto contact with the needle 9062, where the needle 9062 is deflectedand can generate audible sounds (e.g., clicking sounds) to inform thesurgeon the general position of the drive shaft 9002. For example, thetoothed rack 9066 can be formed on the drive shaft 9064 towards aproximal end, and when the needle 9062 is deflected and then released bythe toothed racks 9066, the needle 9062 can generate an audible clip,twang, or ping indicating to the surgeon that the drive shaft 9002 andtherefore the sleds within the staple cartridge are near theirrespective ends. This configuration can advantageously provide usefulfeedback to a device user without interfering with the normal operationsof the device.

In some embodiments, a surgical device such as the above-mentionedsurgical device 1100 can be configured to facilitate articulation of asurgical device's end effector relative to the surgical device'selongate shaft. In other words, the device can be configured tofacilitate angularly offsetting the end effector relative to the shaft,e.g., angularly orienting a longitudinal axis of the end effectorrelative to a longitudinal axis of the shaft. Articulating the endeffector relative to the shaft can help the end effector access targetmaterial at a surgical site. In general, a surgical device including anelongate shaft with an end effector at a distal end thereof can includeat least one support feature configured to strengthen an articulationjoint, also referred to herein as a “flex neck,” where the device canbend to articulate the end effector relative to the shaft. The at leastone support feature can be configured to provide support at thearticulation joint, thereby helping to provide greater flexibility tothe articulation joint, allowing the device to articulate to a higherdegree than it could achieve without the at least one support feature,and/or helping to prevent collapse and/or buckling of the joint so as toreduce effectiveness of a rod extending therethrough. For example, afiring rod (e.g., an I-beam) configured to effect fastener firing and/ora closure rod configured to effect end effector opening/closing canextend through the articulation joint. When the joint bends, the rod(s)extending through the joint also bend, which can cause the rod(s) tocollapse and/or buckle, particularly if the end effector is engagingrelatively thick tissue, thereby reducing the effectiveness of therod(s). The rods can even become entirely unusable if the articulationis to a high enough degree and/or the end effector is engaging thickenough tissue so as to require a higher closing force and/or firingforce. The at least one support feature can be configured to helpprevent such rod ineffectiveness.

A surgical device with an elongate shaft having a relatively smalldiameter and with an end effector having a relatively small diameter,such as surgical devices appropriate for use in minimally invasivesurgery, can be particularly difficult to articulate because of theforces the device can experience during articulation. In some instances,an articulation joint where the device can bend to articulate the endeffector can break or otherwise fail due to these forces, therebyinterrupting and prolonging a surgical procedure and at leasttemporarily rendering the device unusable. The at least one supportfeature can be configured to help prevent such breakage and failure. Asurgical device with an elongate shaft having a relatively smalldiameter and with an end effector having a relatively small diameter canbe difficult to articulate to a desired degree, e.g., up to about 90° orup to about 80°. The at least one support feature can be configured toprovide additional strength to the device's articulation joint, therebyfacilitating articulation of the end effector to a relatively highdegree, e.g., up to about 90° or up to about 80°.

In some embodiments, the at least one support feature can include asupport beam having a plurality of notches formed therein. FIG. 180illustrates one embodiment of an articulation joint 10000 that includesat least one support feature in the form of a support beam 10006 havinga plurality of notches 10012 formed therein. The support beam 10006 canbe disposed within a flexible casing 10002 a, which can form at least adistal portion of the device's elongate shaft. The flexible casing 10002a can facilitate smooth advancement of the articulation joint 10000 intoa patient's body and/or can help protect the notches 10012 disposedtherein. A firing rod 10008 a and a closure rod 10010 a can extendthrough the support beam 10006, and hence also the casing 10002 a. Therods 10008 a, 10010 a be located adjacent to each other laterally, whichcan reduce overall rod buckling, as the articulation join 10000 can beconfigured to articulate laterally, as shown in FIG. 180. As in thisillustrated embodiment, the firing rod 10008 a and closure rod 10010 acan each be slidably disposed in discrete cavities extending through thesupport beam 10006.

A spacer beam 10004 can be located between the two rods 10008, 10010 awithin the support beam 10006, which can help insulate the firing rod10008 a from clamping forces generated by the closure rod 10010 a andhelp insulate the closure rod 10010 a from firing forces generated bythe firing rod 10008 a, thereby helping to improve precise control ofthe rods 10008 a, 10010 a. The spacer beam 10004 can be formed from oneor more materials e.g., a polymer, a slick plastic, glass fillings,etc., that can allow the spacer 10004 beam to bend, as will beappreciated by a person skilled in the art, and facilitate insulationagainst rod forces.

The support beam 10006 can have a rectangular cross-sectional shape, asin this illustrated embodiment. The rectangular shape can help providesupport to the rods 10008 a, 10010 a around an entire perimeter thereof,which can help prevent lateral or horizontal buckling as well asvertical buckling. The support beam 10006 can be formed from arelatively stiff material that has a relatively limited amount offlexibility, which can help provide stability to the rods 10008 a, 10010a disposed therein, e.g., stability during longitudinal translation ofthe rods 10008 a, 10010 a within their respective cavities. Theplurality of notches 100012 formed in the support beam 10006 canfacilitate bending of the support beam 10006 while still allowing thesupport beam 1006 to provide the relatively stiff support to the rods10008 a, 10010 a.

The notches 10012 can have a variety of sizes, shapes, andconfigurations. The notches 10012 can be configured to facilitatearticulation (e.g., bending of the device at the articulation joint10000). The notches 10012 can be configured to reduce an overall forceneeded to articulate the articulation joint 10000 since the notches10012 can help compensate for the relatively stiff material of thesupport beam 10006 that would generally be more difficult to bendwithout the notches 10012 formed therein. As in this illustratedembodiment, the notches 10012 can include vertical cuts, e.g., cutssubstantially perpendicular to a longitudinal axis of the articulationjoint 10000. The notches 10012 can be formed in opposed lateral sides ofthe support beam 10006, thereby corresponding to the lateralarticulation of the articulation join 10000. The support beam 10006 caninclude any number of notches 10012 formed therein.

FIG. 181 illustrates another embodiment of an articulation joint 10013that includes at least one support feature in the form of a support beamhaving a plurality of notches 10014 formed therein. The support beam andthe notches 10014 can generally be configured and used similar to thebeam 10006 and the notches 10012 of FIG. 180. In this illustratedembodiment, instead of the support beam being a singular member as inthe embodiment of FIG. 180, the support beam can include first andsecond support plates 10016 a, 10016 b that together can define thesupport beam through which a firing rod 10008 b, a closure rod 10010 b,and a spacer rod 10018 can longitudinal extend. A flexible casing 10002b can be disposed around the support beam, similar to the flexiblecasing 10002 a of FIG. 180.

The first and second support plates 10016 a, 10016 b can have a varietyof sizes, shapes, and configurations. As in this illustrated embodiment,the first and second support plates 10016 a, 10016 c can each have “L”shaped cross-sectional shapes. The “L” shaped first and second supportplates 10016 a, 10016 b can be arranged relative to one another toprovide support to opposed lateral sides of the rods 10008 a, 10010 band to opposed top and bottom sides of the rods 10008 a, 10010 b, as inthis illustrated embodiment. In some embodiments, the first and secondsupport plates 10016 a, 10016 b can each be formed from a relativelystiff material. In some embodiments, the first and second support plates10016 a, 10016 b can each be formed from a rigid material that generallycannot bend, e.g., a metal such as titanium, etc. The rigid plates canbe attached to each other using a flexing connection element such as aspring, which can facilitate the bending of the articulation joint100013. In some embodiments, the first and second support plates 10016a, 10016 b can be fixed together at one end and coupled to the device'send effector (not shown). In other embodiments, the first and secondsupport plates 10016 a, 10016 b can be entirely floating within thecasing 10002 b, and as such, even when the rods 10008 b, 10010 b arehighly articulated, the support plates 10016 a, 10016 c can beconfigured to not pinch either of the rods 10008 b, 10010 b.

The notches 10012 can have a variety of sizes, shapes, andconfigurations. As in this illustrated embodiment, the notches 10012 caneach include corner cuts be formed in corners of the first and secondsupport plates 10016 a, 10016 b, e.g., where the “L” bends.

FIG. 182 and FIG. 183 illustrate another embodiment of an articulationjoint 10026 that includes at least one support feature in the form of asupport beam 10019. The support beam 10019 can generally be configuredand used similar to the beam 10006 of FIG. 180. The beam 10019 can havea plurality of discrete channels formed therein, each of the channelsbeing configured to movably seat therein one of a first articulation rod10024 a configured to articulate the beam 10019 in a first lateraldirection (e.g., to the right), a second articulation rod 10024 bconfigured to articulate the beam 10019 in a second, opposite lateraldirection (e.g., to the left), a firing rod 10020, and a closure rod10022. Each of the rods 10020, 10022 and the bands 10024 a, 10024 bbeing disposed in its own independent channel within which it canlongitudinally move can help insulate the element 10020, 10022, 10024 a,10024 b within any one of the channels from forces created by theelements in the other three channels. As in this illustrated embodiment,the firing and closure rods 10020, 10022 can be arranged vertically,e.g., in a direction substantially perpendicular to the beam's lateralarticulation, which can help insulate one of the rods 10020, 10022 fromforces from the other one of the rods 10020, 10022 and from forces ofthe articulation bands 10024 a, 10024 b. The beam 10019 can be enclosedby a flexible casing 10027, which is only partially shown in FIG. 182for clarity of illustration of the articulation joint 10026. As shown inthis illustrated embodiment, the firing rod 10020 can include aplurality of flexible laminate bands, and the closure rod 10022 caninclude a plurality of flexible laminate bands.

FIG. 184 illustrates another embodiment of an articulation joint thatincludes at least one support feature in the form of a support beam10029. The support beam 10029 can generally be configured and usedsimilar to the beam 10006 of FIG. 180 and can be enclosed by a flexiblecasing 10034. Similar to the beam 10019 of FIG. 182, the beam 10029 ofFIG. 184 can include a plurality of discrete channels 10033 a, 1033 b,1033 c, 1033 d formed therein, each of the channels 10033 a, 1033 b,1033 c, 1033 d being configured to movably seat therein one of a firstarticulation rod 10035 a configured to articulate the beam 10029 in afirst lateral direction (e.g., to the right), a second articulation rod10035 b configured to articulate the beam 10029 in a second, oppositelateral direction (e.g., to the left), a firing rod 10038, and a closurerod 10037.

In some embodiments, a channel formed in a support beam can include oneor more friction features configured to reduce frictional contact of arod extending through and being movable within the channel. When the rodmoves within the channel, e.g., slides longitudinally therein, the rodcan contact one or more of opposed lateral inner walls and opposed topand bottom inner walls of the channel. This contact can increasefriction and impede the movement of the rod, thereby making the rod'smovement more difficult. The one or more friction features can be formedon one or more of the channel's opposed lateral inner walls and opposedtop and bottom inner wall, thereby reducing the rod's friction with thewall(s) that include the friction feature(s). The one or more frictionfeatures can be configured to help prevent buckling by helping tosupport the rod which the one or more friction features can contact whenthe beam articulates and/or when the rod longitudinally slides withinthe channel.

FIG. 184 illustrates one embodiment of a friction feature 10028 that canbe formed in a support beam channel 10033 a, which is also illustratedin FIG. 185. Only one of the channels 10033 a, 1033 b, 1033 c, 1033 d ofthe beam 10029 includes a friction feature, but any one or more of thechannels 10033 a, 1033 b, 1033 c, 1033 d can include a friction feature.Additionally, although the at least one friction feature 10028 is formedon opposed lateral inner walls 10036 of the firing rod's channel 10033a, the at least one friction feature 10028 can be formed on any one ormore of the channel's inner walls. The at least one friction feature10028 can have a variety of sizes, shapes, and configurations. As inthis illustrated embodiment, the at least one friction feature 10028 caninclude at least one protrusion extending radially inward so as toextend into the channel 10033 a.

FIG. 186, FIG. 187, and FIG. 188 illustrate another embodiment of anarticulation joint 10040 that includes at least one support feature inthe form of a support beam 10042. The support beam 10042 can generallybe configured and used similar to the beam 10006 of FIG. 180. The beam10029 can have a plurality of discrete channels 10032 ₁, 10032 ₂, 10032₃, and 10032 ₄ formed therein, each of the channels 10032 ₁, 10032 ₂,10032 ₃, and 10032 ₄ being configured to movably seat therein one of afirst articulation rod 10044 configured to articulate the beam 10029 ina first lateral direction (e.g., to the right, as shown in FIG. 187 andFIG. 188), a second articulation rod 10406 configured to articulate thebeam 10012 in a second, opposite lateral direction (e.g., to the left),a firing rod 10048, and a closure rod 10500. The firing rod 10048 andthe closure rod 10050 in this illustrated embodiment each include aplurality of flexible laminate bands, as shown in FIG. 188. The rods1044, 1046, 1048, 1050 are omitted from FIG. 186 and FIG. 187 forclarity of illustration.

The beam 10029 can be a single element, as in this illustratedembodiment. The channels 10032 ₁, 10032 ₂, 10032 ₃, and 10032 ₄ can beformed in the beam 10029 in a variety of ways, such as by laser cuttingthe channels 10032 ₁, 10032 ₂, 10032 ₃, and 10032 ₄ therein. Dimensionsof the channels 10032 ₁, 10032 ₂, 10032 ₃, and 10032 ₄ can be tailoredto resist vertical bending while not inhibiting lateral or horizontalbending.

The beam 10029 of this illustrated embodiment can be formed from a moreflexible material than the beam 10019 of FIG. 182, which also has aplurality of discrete channels formed therein, because the beam 10029 ofthis illustrated embodiment can have a cylindrical shape matching acylindrical shape of the device's elongate shaft. In contrast, a beamsuch as the beam 10019 of FIG. 182 having a shape that does not match acylindrical shape of the device's elongate shaft can contain less spacewithin the shaft such that it can be more stiff. Being formed on a moreflexible material, the beam 10029 can be configured to flex in moredirections than a beam formed from a stiffer material.

The beam 10029 can be enclosed by a flexible casing 10030. The casing10030 is omitted from FIG. 188 for clarity of illustration.

A person skilled in the art will appreciate that the present inventionhas application in conventional minimally-invasive and open surgicalinstrumentation as well application in robotic-assisted surgery.

The devices disclosed herein can also be designed to be disposed ofafter a single use, or they can be designed to be used multiple times.In either case, however, the device can be reconditioned for reuse afterat least one use. Reconditioning can include any combination of thesteps of disassembly of the device, followed by cleaning or replacementof particular pieces and subsequent reassembly. In particular, thedevice can be disassembled, and any number of the particular pieces orparts of the device can be selectively replaced or removed in anycombination. Upon cleaning and/or replacement of particular parts, thedevice can be reassembled for subsequent use either at a reconditioningfacility, or by a surgical team immediately prior to a surgicalprocedure. Those skilled in the art will appreciate that reconditioningof a device can utilize a variety of techniques for disassembly,cleaning/replacement, and reassembly. Use of such techniques, and theresulting reconditioned device, are all within the scope of the presentapplication.

One skilled in the art will appreciate further features and advantagesof the invention based on the above-described embodiments. Accordingly,the invention is not to be limited by what has been particularly shownand described, except as indicated by the appended claims. Allpublications and references cited herein are expressly incorporatedherein by reference in their entirety.

What is claimed is:
 1. A surgical device, comprising: a proximal housing; a shaft extending distally from the housing; an end effector coupled to a distal end of the shaft, the end effector including a cartridge jaw and an anvil configured to move between an open position and a closed position in which tissue can be engaged therebetween; an I-beam configured to move distally relative to the cartridge jaw and the anvil and thereby drive staples into tissue engaged between the cartridge jaw and the anvil; an elongate member disposed at least partially in the shaft and configured to move distally relative to the shaft and thereby cause the I-beam to move distally relative to the cartridge jaw and the anvil; and a gear operably coupled to the I-beam configured to be rotated and thereby cause the I-beam to move proximally relative to the cartridge jaw and the anvil.
 2. The device of claim 1, wherein the gear is located in the proximal housing.
 3. The device of claim 1, wherein the gear does not rotate during the distal movement of the elongate member relative to the shaft or during the distal movement of the I-beam relative to the cartridge jaw and anvil.
 4. The device of claim 1, wherein the gear does rotate during the distal movement of the elongate member relative to the shaft and during the distal movement of the I-beam relative to the cartridge jaw and anvil.
 5. The device of claim 1, further comprising an actuator configured to be actuated, thereby causing the elongate member to move distally relative to the shaft and thereby cause the I-beam to move distally relative to the cartridge jaw and the anvil.
 6. The device of claim 5, further comprising a second actuator configured to be actuated, thereby causing the cartridge jaw and the anvil to move from the open position to the closed position.
 7. The device of claim 1, wherein the rotation of the gear also causes the elongate member to move proximally relative to the shaft.
 8. The device of claim 1, wherein the gear is configured to be manually rotated by a user to cause the I-beam to move proximally relative to the cartridge jaw and the anvil.
 9. The device of claim 1, wherein a manual user manipulation of the surgical device is configured to cause the elongate member to move distally relative to the shaft and thereby cause the I-beam to move distally relative to the cartridge jaw and the anvil.
 10. The device of claim 1, wherein a surgical robot is configured to cause the elongate member to move distally relative to the shaft and thereby cause the I-beam to move distally relative to the cartridge jaw and the anvil.
 11. The device of claim 1, further comprising a staple cartridge removably disposable in the cartridge jaw from which the staples are configured to be driven into tissue.
 12. The device of claim 1, further comprising a cutting element configured to move distally relative to the cartridge jaw and the anvil during the driving of the staples to cut the tissue engaged between the cartridge jaw and the anvil.
 13. A surgical method, comprising: engaging tissue between jaws of a surgical device, the surgical device including a proximal housing and including a shaft extending distally from the housing; causing an elongate member disposed at least partially in the shaft to move distally relative to the shaft and thereby cause a cutting element to cut the engaged tissue, and cause an I-beam of the surgical device to move distally relative to the jaws, the distal movement of the I-beam causing staples to be driven from one of the jaws and into the engaged tissue; and after staples have been driven from one of the jaws and into the engaged tissue, causing the I-beam to move proximally relative to the jaws via a manual user input to the surgical device that rotates a gear of the surgical device.
 14. The method of claim 13, wherein the gear does not rotate during the distal movement of the elongate member relative to the shaft or during the distal movement of the I-beam relative to the jaws.
 15. The method of claim 13, wherein causing the elongate member to move distally relative to the shaft and thereby cause an I-beam of the surgical device to move distally relative to the jaws includes actuating an actuator that is operatively coupled to the elongate member.
 16. The method of claim 13, wherein the rotation of the gear also causes the elongate member to move proximally relative to the shaft.
 17. The method of claim 13, wherein manual user manipulation of the surgical device causes the elongate member to move distally relative to the shaft and thereby cause the I-beam to move distally relative to the jaws.
 18. The method of claim 13, wherein a surgical robot causes the elongate member to move distally relative to the shaft and thereby cause the I-beam to move distally relative to the jaws.
 19. The method of claim 13, further comprising, prior to engaging the tissue, removably disposing a staple cartridge in the one of the jaws.
 20. A surgical method, comprising: engaging tissue between jaws of a surgical device, the surgical device including a proximal housing and including a shaft extending distally from the housing, the jaws being coupled to a distal end of the shaft; longitudinally translating an elongate member disposed at least partially in the shaft in a distal direction, the longitudinal translation of the elongate member in the distal direction causing an I-beam of the surgical device to longitudinally translate in the distal direction and thereby cause staples to be driven from one of the jaws and into the engaged tissue; and after staples have been driven from the one of the jaws, longitudinally translating the I-beam in a proximal direction by manually rotating a gear located at the housing of the surgical device; wherein the gear does not rotate during the longitudinal translation of the elongate member in the distal direction or during the longitudinal translation of the I-beam in the distal direction. 